Provider Demographics
NPI:1770196891
Name:THOMAS J HOEFFEL DDS PA
Entity type:Organization
Organization Name:THOMAS J HOEFFEL DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HOEFFEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-631-9010
Mailing Address - Street 1:2819 HAMLINE AVE N STE 104
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-7718
Mailing Address - Country:US
Mailing Address - Phone:651-631-9010
Mailing Address - Fax:651-631-9011
Practice Address - Street 1:2819 HAMLINE AVE N STE 104
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-7718
Practice Address - Country:US
Practice Address - Phone:651-631-9010
Practice Address - Fax:651-631-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty