Healthcare Provider Details

I. General information

NPI: 1326328600
Provider Name (Legal Business Name): CORWYN D HOPKE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40TH AND HOLDREGE STREETS UNMC COLLEGE OF DENTISTRY
LINCOLN NE
68583-0740
US

IV. Provider business mailing address

4928 DUDLEY ST APT 5
LINCOLN NE
68504-3191
US

V. Phone/Fax

Practice location:
  • Phone: 402-472-4919
  • Fax:
Mailing address:
  • Phone: 503-704-3533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6983
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6983
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number6983
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: