1457452864 NPI number — PAUL D HOPKINS DDS PC

Table of content: (NPI 1457452864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457452864 NPI number — PAUL D HOPKINS DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAUL D HOPKINS DDS PC
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:
Provider Other Organization Name Type Code:
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:
1457452864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
859 W PLEASANT VIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLEASANT VIEW
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-737-4477
Provider Business Mailing Address Fax Number:
801-737-0626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4902 S 1900 W SUITE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-773-1234
Provider Business Practice Location Address Fax Number:
801-773-9611
Provider Enumeration Date:
09/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOPKINS
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
DUANE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
801-773-1234

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  144563 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 591998 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 45094675600001 . This is a "BCBS OF UTAH" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 450946756017 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".