Healthcare Provider Details

I. General information

NPI: 1326166539
Provider Name (Legal Business Name): WAYNE ALAN HOVE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W 4TH AVE
STANLEY WI
54768-1002
US

IV. Provider business mailing address

120 W 4TH AVE
STANLEY WI
54768-1002
US

V. Phone/Fax

Practice location:
  • Phone: 715-644-3601
  • Fax: 715-644-3687
Mailing address:
  • Phone: 715-644-3601
  • Fax: 715-644-3687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5002128
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: