Healthcare Provider Details

I. General information

NPI: 1346346533
Provider Name (Legal Business Name): KEVAN RAY HOOVER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 GALEN HEDRICK ROAD
FRANKLIN WV
26807-0447
US

IV. Provider business mailing address

PO BOX 447
FRANKLIN WV
26807-0447
US

V. Phone/Fax

Practice location:
  • Phone: 304-358-2552
  • Fax: 304-358-2552
Mailing address:
  • Phone: 304-358-2552
  • Fax: 304-358-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3077
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: