1962849604 NPI number — DR. RONALD EUGENE HOFFMAN III DMD

Table of content: DR. RONALD EUGENE HOFFMAN III DMD (NPI 1962849604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962849604 NPI number — DR. RONALD EUGENE HOFFMAN III DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOFFMAN
Provider First Name:
RONALD
Provider Middle Name:
EUGENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962849604
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1687
Provider Second Line Business Mailing Address:
5269 HOPKINSVILLE RD
Provider Business Mailing Address City Name:
CADIZ
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42211-1687
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-522-5100
Provider Business Mailing Address Fax Number:
270-522-5103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5269 HOPKINSVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CADIZ
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-522-5100
Provider Business Practice Location Address Fax Number:
270-522-5103
Provider Enumeration Date:
06/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  9300 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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