Provider Demographics
NPI:1992843254
Name:JACK A. HOFFER, DDS, LLC
Entity Type:Organization
Organization Name:JACK A. HOFFER, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-258-9535
Mailing Address - Street 1:187 MILLBURN AVE
Mailing Address - Street 2:SUITE #7
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1847
Mailing Address - Country:US
Mailing Address - Phone:973-258-9535
Mailing Address - Fax:973-258-9093
Practice Address - Street 1:187 MILLBURN AVE
Practice Address - Street 2:SUITE #7
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1847
Practice Address - Country:US
Practice Address - Phone:973-258-9535
Practice Address - Fax:973-258-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI014584001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty