Healthcare Provider Details

I. General information

NPI: 1982147179
Provider Name (Legal Business Name): MICHAEL J HOOVER DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7348 BLONDO ST
OMAHA NE
68134-6910
US

IV. Provider business mailing address

7348 BLONDO ST
OMAHA NE
68134-6910
US

V. Phone/Fax

Practice location:
  • Phone: 402-397-8717
  • Fax:
Mailing address:
  • Phone: 402-397-8717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number3447
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number7162
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number5940
License Number StateNE

VIII. Authorized Official

Name: DR. MICHAEL J HOOVER
Title or Position: PRESIDENT
Credential: DDS
Phone: 402-397-8717