Provider Demographics
NPI:1790181113
Name:HOOVER, KENYA R (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENYA
Middle Name:R
Last Name:HOOVER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KENYA
Other - Middle Name:COSTA
Other - Last Name:DUTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS,MS
Mailing Address - Street 1:106 N DEAN RD STE 140
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-3767
Mailing Address - Country:US
Mailing Address - Phone:407-614-6161
Mailing Address - Fax:
Practice Address - Street 1:106 N DEAN RD STE 140
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-3767
Practice Address - Country:US
Practice Address - Phone:407-614-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-12
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 21489122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist