Provider Demographics
NPI:1083721187
Name:HOPKINS, GARY L (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:HOPKINS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 SOUTH SIDE MALL RD.
Mailing Address - Street 2:401 SOUTH SIDE PROF. BLDG.
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503
Mailing Address - Country:US
Mailing Address - Phone:606-237-0073
Mailing Address - Fax:606-237-9967
Practice Address - Street 1:79 SOUTH SIDE MALL RD
Practice Address - Street 2:401 SOUTH SIDE PROF. BLDG
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-3975
Practice Address - Country:US
Practice Address - Phone:606-237-0073
Practice Address - Fax:606-237-9967
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY53901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice