Healthcare Provider Details

I. General information

NPI: 1881770261
Provider Name (Legal Business Name): KEITH A. HOOVER, APRIL A. YANDA & ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 MILFORD DR
HUDSON OH
44236-2727
US

IV. Provider business mailing address

39 MILFORD DR
HUDSON OH
44236-2727
US

V. Phone/Fax

Practice location:
  • Phone: 330-650-0360
  • Fax: 330-656-9308
Mailing address:
  • Phone: 330-650-0360
  • Fax: 330-656-9308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number16072
License Number StateOH

VIII. Authorized Official

Name: DR. KEITH ARDEN HOOVER
Title or Position: PRESIDENT
Credential: DDS
Phone: 330-650-0360