Provider Demographics
NPI:1134107295
Name:KEITH HOPPER DDS PA
Entity Type:Organization
Organization Name:KEITH HOPPER DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:828-252-0111
Mailing Address - Street 1:4 SMILE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-2065
Mailing Address - Country:US
Mailing Address - Phone:828-252-0111
Mailing Address - Fax:828-252-6777
Practice Address - Street 1:4 SMILE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2065
Practice Address - Country:US
Practice Address - Phone:828-252-0111
Practice Address - Fax:828-252-6777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899009XMedicare ID - Type Unspecified