Healthcare Provider Details

I. General information

NPI: 1417940289
Provider Name (Legal Business Name): JOEL KENNETH HOPKIN DMD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2266 MISSION ST SE
SALEM OR
97302-1267
US

IV. Provider business mailing address

2266 MISSION ST SE
SALEM OR
97302-1267
US

V. Phone/Fax

Practice location:
  • Phone: 503-375-2000
  • Fax: 503-375-3125
Mailing address:
  • Phone: 503-375-2000
  • Fax: 503-375-3125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberD7858
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: