Provider Demographics
NPI:1457575870
Name:HOUGEN, OLIVIA SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:SCOTT
Last Name:HOUGEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1696
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-1696
Mailing Address - Country:US
Mailing Address - Phone:907-543-4311
Mailing Address - Fax:
Practice Address - Street 1:826 CHIEF EDDIE HOFFMAN HIGHWAY
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559
Practice Address - Country:US
Practice Address - Phone:907-543-6619
Practice Address - Fax:907-543-6393
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD0797Medicaid