Healthcare Provider Details

I. General information

NPI: 1093952962
Provider Name (Legal Business Name): BONNIE MAIE HOOPER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 CAMINO DEL RIO SUITE 316
DURANGO CO
81301-5466
US

IV. Provider business mailing address

PO BOX 140
DURANGO CO
81302-0140
US

V. Phone/Fax

Practice location:
  • Phone: 970-385-4480
  • Fax: 970-385-4480
Mailing address:
  • Phone: 970-247-5702
  • Fax: 970-247-9126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number905563
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: