Healthcare Provider Details

I. General information

NPI: 1285302935
Provider Name (Legal Business Name): JESSICA HOVANEC PHDHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 LIBERTY AVE
PITTSBURGH PA
15222-1220
US

IV. Provider business mailing address

411 MAXWELL DR
PITTSBURGH PA
15236-2039
US

V. Phone/Fax

Practice location:
  • Phone: 412-760-8340
  • Fax:
Mailing address:
  • Phone: 412-760-8340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberPHDH001036
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: