Provider Demographics
NPI:1235368150
Name:AMANDA G HOOVER, DDS, PC
Entity Type:Organization
Organization Name:AMANDA G HOOVER, DDS, PC
Other - Org Name:THE LAKES DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-334-5354
Mailing Address - Street 1:6455 S SHORE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-5525
Mailing Address - Country:US
Mailing Address - Phone:281-334-5354
Mailing Address - Fax:281-334-5344
Practice Address - Street 1:6455 S SHORE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-5525
Practice Address - Country:US
Practice Address - Phone:281-334-5354
Practice Address - Fax:281-334-5344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty