Healthcare Provider Details

I. General information

NPI: 1669690475
Provider Name (Legal Business Name): RICHARD ALLEN HOVDA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 N 17TH AVE
WAUSAU WI
54401-2910
US

IV. Provider business mailing address

7020 HILLCREST DR
WAUSAU WI
54401-9732
US

V. Phone/Fax

Practice location:
  • Phone: 715-842-5459
  • Fax: 715-848-1849
Mailing address:
  • Phone: 715-675-9419
  • Fax: 714-848-1849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3774
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: