Provider Demographics
NPI:1972797017
Name:HOEKSTRA, CARLA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:
Last Name:HOEKSTRA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 FLOYD BLVD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51108-1552
Mailing Address - Country:US
Mailing Address - Phone:712-239-5812
Mailing Address - Fax:712-239-0662
Practice Address - Street 1:3900 FLOYD BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51108-1552
Practice Address - Country:US
Practice Address - Phone:712-239-5812
Practice Address - Fax:712-239-0662
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA085051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA08505OtherGENERAL LICENSE