Provider Demographics
NPI:1962825927
Name:JOAN HOVERMAN, DDS
Entity Type:Organization
Organization Name:JOAN HOVERMAN, DDS
Other - Org Name:DBA: AESTHETE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-530-3191
Mailing Address - Street 1:4100 W MAPLE ST
Mailing Address - Street 2:C/O FAMILY DENTISTRY & PREVENTIVE CARE
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-2538
Mailing Address - Country:US
Mailing Address - Phone:316-530-3191
Mailing Address - Fax:
Practice Address - Street 1:4100 W MAPLE ST
Practice Address - Street 2:C/O FAMILY DENTISTRY & PREVENTIVE CARE BUILDING
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-2538
Practice Address - Country:US
Practice Address - Phone:316-530-3191
Practice Address - Fax:316-854-0821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS602511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty