Provider Demographics
NPI:1205924123
Name:HOFFMAN, DONALD L (DDS PHD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:L
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:DDS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 PARK AVENUE WEST
Mailing Address - Street 2:SUITE 2 - SOUTH
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035
Mailing Address - Country:US
Mailing Address - Phone:847-432-0304
Mailing Address - Fax:847-432-2560
Practice Address - Street 1:1160 PARK AVENUE WEST
Practice Address - Street 2:SUITE 2 - SOUTH
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035
Practice Address - Country:US
Practice Address - Phone:847-432-0304
Practice Address - Fax:847-432-2560
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
K20738Medicare ID - Type Unspecified
T38608Medicare UPIN