# CEDAR LAKE DENTAL, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538956750
- **Authorized official:** IAN HOFFMAN DDS (OWNER)
- **Authorized official phone:** (773) 820-2587

## Contact information

- **Practice address:** 13136 LAKE SHORE DR, CEDAR LAKE, IN 46303-9576
- **Practice address phone:** (219) 323-6777
- **Mailing address:** 1926 N LINCOLN PARK W APT 3B, CHICAGO, IL 60614-8017
- **Mailing address phone:** (773) 820-2587

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 04/22/2025
- **Last updated:** 04/22/2025