Healthcare Provider Details

I. General information

NPI: 1184613390
Provider Name (Legal Business Name): DARREN EUGENE HOVLAND D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 EVERGREEN LN N
PLYMOUTH MN
55441-4800
US

IV. Provider business mailing address

1304 W MEDICINE LAKE DR #203
PLYMOUTH MN
55441-4860
US

V. Phone/Fax

Practice location:
  • Phone: 763-546-2209
  • Fax: 763-546-9107
Mailing address:
  • Phone: 763-546-0177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11182
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: