Provider Demographics
NPI:1669690475
Name:HOVDA, RICHARD ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLEN
Last Name:HOVDA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7020 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-9732
Mailing Address - Country:US
Mailing Address - Phone:715-675-9419
Mailing Address - Fax:714-848-1849
Practice Address - Street 1:519 N 17TH AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2910
Practice Address - Country:US
Practice Address - Phone:715-842-5459
Practice Address - Fax:715-848-1849
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics