Provider Demographics
NPI:1013004050
Name:HOVLIARAS, PAMELA A (DMD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:HOVLIARAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 ROUTE 10 WEST
Mailing Address - Street 2:
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876
Mailing Address - Country:US
Mailing Address - Phone:862-251-7140
Mailing Address - Fax:862-251-7142
Practice Address - Street 1:26 ROUTE 10 WEST
Practice Address - Street 2:
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876
Practice Address - Country:US
Practice Address - Phone:862-251-7140
Practice Address - Fax:862-251-7142
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI195001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice