1962825927 NPI number — JOAN HOVERMAN, DDS

Table of content: (NPI 1962825927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962825927 NPI number — JOAN HOVERMAN, DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOAN HOVERMAN, DDS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DBA: AESTHETE DENTISTRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962825927
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4100 W MAPLE ST
Provider Second Line Business Mailing Address:
C/O FAMILY DENTISTRY & PREVENTIVE CARE
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67209-2538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-530-3191
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4100 W MAPLE ST
Provider Second Line Business Practice Location Address:
C/O FAMILY DENTISTRY & PREVENTIVE CARE BUILDING
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67209-2538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-530-3191
Provider Business Practice Location Address Fax Number:
316-854-0821
Provider Enumeration Date:
01/28/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOVERMAN
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER / OPERATOR
Authorized Official Telephone Number:
316-530-3191

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  60251 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)