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NPI Code Detail

MEDICARE: DURSTIN W HOOPERPLLC

MEDICARE: DURSTIN W HOOPERPLLC
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
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1821715442
Entity Type Code : Organization
Provider Name (Legal Business Name) : DURSTIN W HOOPERPLLC
Provider Business Mailing Address
First Line : 300 W AIRPORT RD
Second Line :
City : PAYSON
State : AZ
Zip : 85541-3607
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 300 W AIRPORT RD
Second Line :
City : PAYSON
State : AZ
Zip : 85541-3607
Country : US
Telephone Number : 435-215-9694
Fax Number :
Authorized Official
Title or Position : OWNER/DENTIST
Name : DURSTIN HOOPER
Credential : DDS
Telephone Number : 435-215-9694
Provider Enumeration Date : 10/25/2022
Last Update Date : 10/25/2022

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Directions to “DURSTIN W HOOPERPLLC ” Practice Location

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