# MAIN STREET FAMILY DENTISTRY, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336506849
- **Authorized official:** DR. KENNETH S HOOVER DMD (OWNER)
- **Authorized official phone:** (609) 953-7199

## Contact information

- **Practice address:** 76 N MAIN ST, MEDFORD, NJ 08055-2720
- **Practice address phone:** (609) 953-7199
- **Mailing address:** 76 N MAIN ST, MEDFORD, NJ 08055-2720
- **Mailing address phone:** (609) 953-7199

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 16152 | NJ | Yes |
| 1223G0001X | General Practice Dentistry | 16511 | — | — |

## Other

- **Enumeration date:** 01/28/2016
- **Last updated:** 01/28/2016