Provider Demographics
NPI:1720193683
Name:CHARLES W HOOVER DDS PA
Entity Type:Organization
Organization Name:CHARLES W HOOVER DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-249-9822
Mailing Address - Street 1:539 EAST CENTER STREET
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292
Mailing Address - Country:US
Mailing Address - Phone:336-249-9822
Mailing Address - Fax:336-249-9822
Practice Address - Street 1:539 EAST CENTER STREET
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292
Practice Address - Country:US
Practice Address - Phone:336-249-9822
Practice Address - Fax:336-249-9822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty