Healthcare Provider Details

I. General information

NPI: 1205820180
Provider Name (Legal Business Name): JASON TODD HOOPER D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5927 SE BABB RD
BELLEVIEW FL
34420-4105
US

IV. Provider business mailing address

3920 SW 21ST ST
GAINESVILLE FL
32608-3309
US

V. Phone/Fax

Practice location:
  • Phone: 352-245-9184
  • Fax: 352-245-2705
Mailing address:
  • Phone: 352-359-4371
  • Fax: 352-245-2705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN17112
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: