Healthcare Provider Details

I. General information

NPI: 1922113265
Provider Name (Legal Business Name): JAMES W HOVER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 23RD AVE
MERIDIAN MS
39301
US

IV. Provider business mailing address

1210 23RD AVE
MERIDIAN MS
39301
US

V. Phone/Fax

Practice location:
  • Phone: 601-693-1604
  • Fax: 601-693-1616
Mailing address:
  • Phone: 601-693-1604
  • Fax: 601-693-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number180378
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: