Provider Demographics
NPI:1164509824
Name:HOOVER, JOHN POLLARD JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:POLLARD
Last Name:HOOVER
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 SHALLOWFORD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7802
Mailing Address - Country:US
Mailing Address - Phone:423-894-8942
Mailing Address - Fax:
Practice Address - Street 1:6101 SHALLOWFORD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7802
Practice Address - Country:US
Practice Address - Phone:423-894-8942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0069181223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0171297Medicaid