1013938117 NPI number — OUCP DENTAL SERVICE

Table of content: MR. BRIAN ROBERT HOPP PA (NPI 1932282449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013938117 NPI number — OUCP DENTAL SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUCP DENTAL SERVICE
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:
1013938117
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 N. PHILLIPS AVE.
Provider Second Line Business Mailing Address:
SUITE 8900
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-271-4750
Provider Business Mailing Address Fax Number:
405-271-4055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 N. PHILLIPS AVE.
Provider Second Line Business Practice Location Address:
SUITE 8900
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-271-4750
Provider Business Practice Location Address Fax Number:
405-271-4055
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
CLINIC DIRECTOR
Authorized Official Telephone Number:
405-271-4750

Provider Taxonomy Codes

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

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

  • Identifier: 100749330A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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