Healthcare Provider Details

I. General information

NPI: 1689640898
Provider Name (Legal Business Name): PRICE EDWIN HOPSON JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 SPRING ST
DOVER TN
37058
US

IV. Provider business mailing address

2407 MEMORIAL DR EXT
CLARKSVILLE TN
37043
US

V. Phone/Fax

Practice location:
  • Phone: 931-232-5329
  • Fax: 931-232-7247
Mailing address:
  • Phone: 931-648-4068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS2109
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: