Healthcare Provider Details

I. General information

NPI: 1225964562
Provider Name (Legal Business Name): MCDONNELL HOVENCAMP DENTAL CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 REED CANAL RD STE 101
PORT ORANGE FL
32129-9460
US

IV. Provider business mailing address

1440 REED CANAL RD STE 101
PORT ORANGE FL
32129-9460
US

V. Phone/Fax

Practice location:
  • Phone: 386-410-4943
  • Fax:
Mailing address:
  • Phone: 386-410-4943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JUDITH MCDONNELL
Title or Position: OWNER
Credential: DDS
Phone: 386-410-4943