Provider Demographics
NPI:1417032707
Name:HOOVER, STEPHEN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:P
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 1:135 N SANDUSKY AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-1253
Mailing Address - Country:US
Mailing Address - Phone:419-294-2436
Mailing Address - Fax:419-294-1821
Practice Address - Street 1:135 N SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:UPPER SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:43351-1253
Practice Address - Country:US
Practice Address - Phone:419-294-2436
Practice Address - Fax:419-294-1821
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH154491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0336881Medicaid