Provider Demographics
NPI:1376226464
Name:DOVE HYDRATION & WELLNESS, LLC
Entity Type:Organization
Organization Name:DOVE HYDRATION & WELLNESS, LLC
Other - Org Name:DOVE HYDRATION & WELLNESS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:MORENIKE
Authorized Official - Last Name:ODUWOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-775-7739
Mailing Address - Street 1:950 N 35TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-3318
Mailing Address - Country:US
Mailing Address - Phone:414-775-7739
Mailing Address - Fax:
Practice Address - Street 1:950 N 35TH ST FL 2
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-3318
Practice Address - Country:US
Practice Address - Phone:414-775-7739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty