Provider Demographics
NPI:1295562817
Name:HOFMANN, GRANT JEFFREY (DDS)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:JEFFREY
Last Name:HOFMANN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 LOMBARD ST APT 29
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-9105
Mailing Address - Country:US
Mailing Address - Phone:916-990-6068
Mailing Address - Fax:
Practice Address - Street 1:2370 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1696
Practice Address - Country:US
Practice Address - Phone:415-552-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110778122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist