MEDICARE: DR. JOHN CARTER HOPPIN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	11530	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11530	OTHER	MO	STATE

General Provider Information

NPI Number	:	1053472100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN CARTER HOPPIN DDS

Provider Business Mailing Address
First Line	:	14301 CONWAY RD
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017
Country	:	US
Telephone Number	:	314-469-3320
Fax Number	:	314-469-3373

Provider Business Practice Location Address
First Line	:	1 WESTBURY DR
Second Line	:	STE 300 BLDG C
City	:	ST CHARLES
State	:	MO
Zip	:	63301-2541
Country	:	US
Telephone Number	:	636-946-9890
Fax Number	:	636-946-7195

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/08/2007

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