Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | D7710 | OR |
NPI | 1043218456 |
---|---|
Provider Name | Ann Marie Hofbauer |
First Address | Mcminnville, OR 97128-5444 |
Second Address | Mcminnville, OR 97128-5444 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2005 |
Last Update Date | 03/03/2015 |