MEDICARE: DOUG HOPE, DDS, PROF. DENTAL CORP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	45574	CA

General Provider Information

NPI Number	:	1225372634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUG HOPE, DDS, PROF. DENTAL CORP.

Provider Business Mailing Address
First Line	:	6903 AMBER LN
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-1725
Country	:	US
Telephone Number	:	760-505-9112
Fax Number	:

Provider Business Practice Location Address
First Line	:	933 VALE TERRACE DR
Second Line	:	SUITE A
City	:	VISTA
State	:	CA
Zip	:	92084-5213
Country	:	US
Telephone Number	:	760-724-1011
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DOUGLAS HOPE
Credential	:	DDS
Telephone Number	:	760-505-9112

Provider Enumeration Date	:	11/26/2012
Last Update Date	:	11/26/2012

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