Organization
AUSTIN D HOOVER DDS DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AUSTIN DERYCK HOOVER DDS (PRESIDENT)
(951) 205-5790
Entity
Organization
Contact information
Practice address
801 N TUSTIN AVE STE 705, SANTA ANA, CA 92705-3611
(714) 835-8873
Mailing address
801 N TUSTIN AVE STE 705, SANTA ANA, CA 92705-3611
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
61621
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1467700039
NPI
CA
01
—
61621
DDS LICENSE
CA
Enumeration date
06/02/2016
Last updated
06/02/2016
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