Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 14509 | MD |
NPI | 1053645408 |
---|---|
Provider Name | Dr. Daniel Hoffacker |
First Address | Westminster, MD 21157-5632 |
Second Address | Westminster, MD 21157 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2009 |
Last Update Date | 26/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14509 | MARYLAND STATE DENTAL BOARD (01) | MD |