Provider Demographics
NPI:1720399017
Name:HOVERSTAD, ERIC DEUBLER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DEUBLER
Last Name:HOVERSTAD
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 1:3809 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:919-247-8404
Mailing Address - Fax:
Practice Address - Street 1:3809 COMPUTER DR STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6518
Practice Address - Country:US
Practice Address - Phone:919-298-2820
Practice Address - Fax:919-844-2856
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL109271223S0112X
NC89341223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery