Provider Demographics
NPI:1346346533
Name:HOOVER, KEVAN RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVAN
Middle Name:RAY
Last Name:HOOVER
Suffix:
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:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WV
Mailing Address - Zip Code:26807-0447
Mailing Address - Country:US
Mailing Address - Phone:304-358-2552
Mailing Address - Fax:304-358-2552
Practice Address - Street 1:38 GALEN HEDRICK ROAD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WV
Practice Address - Zip Code:26807-0447
Practice Address - Country:US
Practice Address - Phone:304-358-2552
Practice Address - Fax:304-358-2552
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3077122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0133144000Medicaid