Healthcare Provider Details

I. General information

NPI: 1376827832
Provider Name (Legal Business Name): DUSTIN J HOPKIN DDS, ORAL AND MAXILLOFACIAL SURGERY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 E 4500 S STE 285
SALT LAKE CITY UT
84117-4028
US

IV. Provider business mailing address

2180 E 4500 S STE 285
SALT LAKE CITY UT
84117-4028
US

V. Phone/Fax

Practice location:
  • Phone: 801-277-3942
  • Fax: 801-277-4505
Mailing address:
  • Phone: 801-277-3942
  • Fax: 801-277-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number7752965
License Number StateUT

VIII. Authorized Official

Name: DR. DUSTIN JOHN HOPKIN
Title or Position: PRESIDENT
Credential: DDS
Phone: 801-277-3942