Healthcare Provider Details

I. General information

NPI: 1184554313
Provider Name (Legal Business Name): LAUREN HOPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 NW 2ND AVE
GRAND RAPIDS MN
55744-2627
US

IV. Provider business mailing address

13010 MAYWOOD LN
MINNETONKA MN
55343-8793
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-1266
  • Fax:
Mailing address:
  • Phone: 952-250-4485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD15450
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: