Provider Demographics
NPI:1497317309
Name:HOOVER, ALYSSA MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:MARIE
Last Name:HOOVER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-5577
Mailing Address - Country:US
Mailing Address - Phone:317-437-4669
Mailing Address - Fax:
Practice Address - Street 1:5406 S EMERSON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-1970
Practice Address - Country:US
Practice Address - Phone:317-780-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013204A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist