Healthcare Provider Details

I. General information

NPI: 1255454146
Provider Name (Legal Business Name): MERAMEC VALLEY DENTAL, LAURA HOOVER, DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 VANCE RD SUITE 100
VALLEY PARK MO
63088-1597
US

IV. Provider business mailing address

298 VANCE RD SUITE 100
VALLEY PARK MO
63088-1597
US

V. Phone/Fax

Practice location:
  • Phone: 636-861-0807
  • Fax: 636-825-7040
Mailing address:
  • Phone: 636-861-0807
  • Fax: 636-825-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE 15732
License Number StateMO

VIII. Authorized Official

Name: DR. LAURA MAXINE HOOVER
Title or Position: DENTIST
Credential: D.M.D.
Phone: 636-861-0807