Healthcare Provider Details

I. General information

NPI: 1134818941
Provider Name (Legal Business Name): WILLIAM SHELBY HOVANDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/18/2025
Certification Date: 05/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11605 STATE AVE STE 108
MARYSVILLE WA
98271-8427
US

IV. Provider business mailing address

1009 GLEN ST
EDMONDS WA
98020-2948
US

V. Phone/Fax

Practice location:
  • Phone: 360-386-9540
  • Fax:
Mailing address:
  • Phone: 425-331-9986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number61445949
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: