Provider Demographics
NPI:1770847873
Name:HOFFMAN, DEREK ADAM (DMD, MS)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:ADAM
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 KINGSLEY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4528
Mailing Address - Country:US
Mailing Address - Phone:904-264-4519
Mailing Address - Fax:904-264-4510
Practice Address - Street 1:1406 KINGSLEY AVE STE B
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4528
Practice Address - Country:US
Practice Address - Phone:904-264-4519
Practice Address - Fax:904-264-4510
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL209791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics