MEDICARE: DR. ELYSSA JO HOOPES DMD

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	1223G0001X	General Practice Dentistry	8042	AZ
2	1223G0001X	General Practice Dentistry	DD3409	NM

General Provider Information

NPI Number	:	1750695003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELYSSA JO HOOPES DMD

Provider Business Mailing Address
First Line	:	711 6TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4352
Country	:	US
Telephone Number	:	505-425-7574
Fax Number	:	505-425-7554

Provider Business Practice Location Address
First Line	:	711 6TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4352
Country	:	US
Telephone Number	:	505-425-7574
Fax Number	:	505-425-7554

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

Provider Enumeration Date	:	07/28/2010
Last Update Date	:	12/28/2010

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