MEDICARE: DR. ALYSSA MARIE HOOVER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	12013204A	IN

General Provider Information

NPI Number	:	1497317309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALYSSA MARIE HOOVER DMD

Provider Business Mailing Address
First Line	:	501 VIRGINIA AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-5577
Country	:	US
Telephone Number	:	317-437-4669
Fax Number	:

Provider Business Practice Location Address
First Line	:	5406 S EMERSON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-1970
Country	:	US
Telephone Number	:	317-780-7777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2019
Last Update Date	:	07/01/2019

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Directions to “ DR. ALYSSA MARIE HOOVER DMD” Practice Location

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