Provider Demographics
NPI:1952376568
Name:HOOVER, THOMAS ELLIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ELLIS
Last Name:HOOVER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8913 NORWAY ST. NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433
Mailing Address - Country:US
Mailing Address - Phone:612-387-4797
Mailing Address - Fax:
Practice Address - Street 1:2121 CLIFF DR
Practice Address - Street 2:SUITE 215
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3335
Practice Address - Country:US
Practice Address - Phone:651-452-4828
Practice Address - Fax:651-681-0856
Is Sole Proprietor?:No
Enumeration Date:2006-02-18
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11710122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist