Provider Demographics
NPI:1376554634
Name:HOVDA, CAMI L (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAMI
Middle Name:L
Last Name:HOVDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 W CARMEL DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5806
Mailing Address - Country:US
Mailing Address - Phone:317-844-0022
Mailing Address - Fax:317-844-0021
Practice Address - Street 1:715 W CARMEL DR
Practice Address - Street 2:SUITE 103
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5806
Practice Address - Country:US
Practice Address - Phone:317-844-0022
Practice Address - Fax:317-844-0021
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120107071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200306720Medicaid