Provider Demographics
NPI:1982147179
Name:MICHAEL J HOOVER DDS PC
Entity Type:Organization
Organization Name:MICHAEL J HOOVER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-397-8717
Mailing Address - Street 1:7348 BLONDO ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-6910
Mailing Address - Country:US
Mailing Address - Phone:402-397-8717
Mailing Address - Fax:
Practice Address - Street 1:7348 BLONDO ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-6910
Practice Address - Country:US
Practice Address - Phone:402-397-8717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5940261QD0000X
NE3447261QD0000X
NE7162261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100259539-00Medicaid
NE470599282-00Medicaid