MEDICARE: DR. NORAH HOVERSON 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	D14113	MN

General Provider Information

NPI Number	:	1982097325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NORAH HOVERSON D.D.S.

Provider Business Mailing Address
First Line	:	825 NICOLLET MALL STE 1737
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55402-2704
Country	:	US
Telephone Number	:	612-332-1164
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 NICOLLET MALL STE 1737
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55402-2704
Country	:	US
Telephone Number	:	612-332-1164
Fax Number	:

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

Provider Enumeration Date	:	03/10/2015
Last Update Date	:	12/22/2020

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