Provider Demographics
NPI:1043934763
Name:BOPP, VANESSA KAY (RDH)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:KAY
Last Name:BOPP
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E BOULEVARD AVE DEPT 301
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58505-0602
Mailing Address - Country:US
Mailing Address - Phone:701-328-2356
Mailing Address - Fax:
Practice Address - Street 1:600 E BOULEVARD AVE DEPT 301
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58505-0602
Practice Address - Country:US
Practice Address - Phone:701-328-2356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND14681223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health