Provider Demographics
NPI:1093838989
Name:HOOVER, LAURA MAXINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MAXINE
Last Name:HOOVER
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 1:298 VANCE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VALLEY PARK
Mailing Address - State:MO
Mailing Address - Zip Code:63088-1597
Mailing Address - Country:US
Mailing Address - Phone:636-861-0807
Mailing Address - Fax:636-825-7040
Practice Address - Street 1:298 VANCE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:VALLEY PARK
Practice Address - State:MO
Practice Address - Zip Code:63088-1597
Practice Address - Country:US
Practice Address - Phone:636-861-0807
Practice Address - Fax:636-825-7040
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE 15732122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist