=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467744235
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | G. DOUGLAS HOOVER DDS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2011
-----------------------------------------------------
Last Update Date | 05/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 474 S LOCUST ST
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45056-2127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-523-7515
-----------------------------------------------------
Fax | 513-523-6028
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 474 S. LOCUST ST
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45056-2127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-523-7515
-----------------------------------------------------
Fax | 513-523-6028
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES
-----------------------------------------------------
Name | DR. G DOUGLAS HOOVER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 513-523-7515
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 14299
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------