Healthcare Provider Details

I. General information

NPI: 1225141831
Provider Name (Legal Business Name): MARY BERNADETTE HOVEL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3511 EAST AVE SO
LACROSSE WI
54601
US

IV. Provider business mailing address

3511 EAST AVE SO
LACROSSE WI
54601
US

V. Phone/Fax

Practice location:
  • Phone: 608-788-2016
  • Fax: 608-788-2087
Mailing address:
  • Phone: 608-788-2016
  • Fax: 608-788-2087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3491
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: