Provider Demographics
NPI:1740205467
Name:STOVER, JOHN D (DDS,MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:STOVER
Suffix:
Gender:M
Credentials:DDS,MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 KINOOLE ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3829
Mailing Address - Country:US
Mailing Address - Phone:808-969-1818
Mailing Address - Fax:808-969-1838
Practice Address - Street 1:784 KINOOLE ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3829
Practice Address - Country:US
Practice Address - Phone:808-969-1818
Practice Address - Fax:808-969-1838
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21271223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI2127OtherHDS
HI508872-04Medicaid
HIF231925OtherHMSA
HI212701OtherHDS
HI7764386OtherAETNA
HIC234223OtherHMSA DENTAL
HIF234226OtherHMSA DENTAL
HI212702OtherHDS
HI508872-03Medicaid
HIC231922OtherHMSA
HI508872-02Medicaid
HI990358636OtherHMAA
HIE231927OtherHMSA
HIE234228OtherHMSA DENTAL
HIF234226OtherHMSA DENTAL