Provider Demographics
NPI:1205820180
Name:HOOPER, JASON TODD (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:TODD
Last Name:HOOPER
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 1:3920 SW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-3309
Mailing Address - Country:US
Mailing Address - Phone:352-359-4371
Mailing Address - Fax:352-245-2705
Practice Address - Street 1:5927 SE BABB RD
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-4105
Practice Address - Country:US
Practice Address - Phone:352-245-9184
Practice Address - Fax:352-245-2705
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN171121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice