MEDICARE: DUSTIN J HOPKIN DDS, ORAL AND MAXILLOFACIAL SURGERY P.C.

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	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center	7752965	UT

General Provider Information

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

Provider Business Mailing Address
First Line	:	2180 E 4500 S STE 285
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4028
Country	:	US
Telephone Number	:	801-277-3942
Fax Number	:	801-277-4505

Provider Business Practice Location Address
First Line	:	2180 E 4500 S STE 285
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4028
Country	:	US
Telephone Number	:	801-277-3942
Fax Number	:	801-277-4505

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DUSTIN JOHN HOPKIN
Credential	:	DDS
Telephone Number	:	801-277-3942

Provider Enumeration Date	:	10/03/2011
Last Update Date	:	11/14/2016

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