MEDICARE: DR. VAN LUKE HOPKINS DDS

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	2024019288	MO

General Provider Information

NPI Number	:	1619719705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VAN LUKE HOPKINS DDS

Provider Business Mailing Address
First Line	:	3904 BECK RD STE 110
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-5037
Country	:	US
Telephone Number	:	816-233-2672
Fax Number	:

Provider Business Practice Location Address
First Line	:	3904 BECK RD STE 110
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-5037
Country	:	US
Telephone Number	:	816-233-2672
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2024
Last Update Date	:	06/10/2024

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