MEDICARE: DR. REX WILLIAM HOOVER D.D.S.

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	24119	CA

General Provider Information

NPI Number	:	1770795163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REX WILLIAM HOOVER D.D.S.

Provider Business Mailing Address
First Line	:	14475 SOBEY RD
Second Line	:
City	:	SARATOGA
State	:	CA
Zip	:	95070-5608
Country	:	US
Telephone Number	:	408-867-4209
Fax Number	:	408-559-5035

Provider Business Practice Location Address
First Line	:	3990 S BASCOM AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-2663
Country	:	US
Telephone Number	:	408-356-5161
Fax Number	:	408-559-5035

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

Provider Enumeration Date	:	05/05/2007
Last Update Date	:	07/08/2007

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