Provider Demographics
NPI:1871708131
Name:HOFER FAMILY DENTISTRY
Entity type:Organization
Organization Name:HOFER FAMILY DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HOFER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-223-2021
Mailing Address - Street 1:304 ISLAND DR.
Mailing Address - Street 2:
Mailing Address - City:FT. PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57532-7305
Mailing Address - Country:US
Mailing Address - Phone:605-223-2021
Mailing Address - Fax:605-223-9021
Practice Address - Street 1:304 ISLAND DR.
Practice Address - Street 2:
Practice Address - City:FT. PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57532-7305
Practice Address - Country:US
Practice Address - Phone:605-223-2021
Practice Address - Fax:605-223-9021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD06061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty