Healthcare Provider Details

I. General information

NPI: 1821072695
Provider Name (Legal Business Name): TRACY LYNN HOPKINS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 MAIN ST
DARLINGTON WI
53530-1427
US

IV. Provider business mailing address

74 ECLIPSE CTR
BELOIT WI
53511-3550
US

V. Phone/Fax

Practice location:
  • Phone: 608-776-2082
  • Fax:
Mailing address:
  • Phone: 608-361-0311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8211
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5097-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: