Provider Demographics
NPI:1528399805
Name:HOVER DENTAL GROUP
Entity Type:Organization
Organization Name:HOVER DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KOCHEVAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-684-9700
Mailing Address - Street 1:1446 HOVER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-2485
Mailing Address - Country:US
Mailing Address - Phone:303-684-9700
Mailing Address - Fax:303-684-9777
Practice Address - Street 1:1446 HOVER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2485
Practice Address - Country:US
Practice Address - Phone:303-684-9700
Practice Address - Fax:303-684-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty