Provider Demographics
NPI:1093952962
Name:HOOPER, BONNIE MAIE (RDH)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:MAIE
Last Name:HOOPER
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:PO BOX 140
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81302-0140
Mailing Address - Country:US
Mailing Address - Phone:970-247-5702
Mailing Address - Fax:970-247-9126
Practice Address - Street 1:701 CAMINO DEL RIO
Practice Address - Street 2:SUITE 316
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5466
Practice Address - Country:US
Practice Address - Phone:970-385-4480
Practice Address - Fax:970-385-4480
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO905563124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist