Healthcare Provider Details

I. General information

NPI: 1154820355
Provider Name (Legal Business Name): ERIC D. HOVERSTAD, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2018
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 COMPUTER DR STE 101
RALEIGH NC
27609-6518
US

IV. Provider business mailing address

3809 COMPUTER DR STE 101
RALEIGH NC
27609-6518
US

V. Phone/Fax

Practice location:
  • Phone: 919-298-2820
  • Fax: 919-844-2856
Mailing address:
  • Phone: 919-298-2820
  • Fax: 919-844-2856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8934
License Number StateNC

VIII. Authorized Official

Name: DR. ERIC DEUBLER HOVERSTAD
Title or Position: OWNER
Credential: DDS
Phone: 919-298-2820