Provider Demographics
NPI:1497529598
Name:ERIC D. HOVERSTAD DDS PLLC II
Entity Type:Organization
Organization Name:ERIC D. HOVERSTAD DDS PLLC II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:HOVERSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-247-8404
Mailing Address - Street 1:3809 COMPUTER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6518
Mailing Address - Country:US
Mailing Address - Phone:984-258-2727
Mailing Address - Fax:919-844-2856
Practice Address - Street 1:220 SPRINGBROOK AVE STE 110
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-5311
Practice Address - Country:US
Practice Address - Phone:919-585-7646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery