Healthcare Provider Details

I. General information

NPI: 1720399017
Provider Name (Legal Business Name): ERIC DEUBLER HOVERSTAD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2010
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: 919-247-8404
  • Fax:

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:
Title or Position:
Credential:
Phone: