Healthcare Provider Details

I. General information

NPI: 1285638833
Provider Name (Legal Business Name): CRAIG J HOVICK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 17TH AVE STE 101
LONGMONT CO
80501-2647
US

IV. Provider business mailing address

1055 17TH AVE STE 101
LONGMONT CO
80501-2647
US

V. Phone/Fax

Practice location:
  • Phone: 303-678-5253
  • Fax: 303-678-1054
Mailing address:
  • Phone: 303-678-5253
  • Fax: 303-678-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number105418
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: