Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 014417 | MO |
NPI | 1114960648 |
---|---|
Provider Name | Donald C Hofheins |
First Address | Chesterfield, MO 63005-1361 |
Second Address | Chesterfield, MO 63005-1361 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 08/07/2007 |