Provider Demographics
NPI:1225372634
Name:DOUG HOPE, DDS, PROF. DENTAL CORP.
Entity Type:Organization
Organization Name:DOUG HOPE, DDS, PROF. DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-505-9112
Mailing Address - Street 1:6903 AMBER LN
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-1725
Mailing Address - Country:US
Mailing Address - Phone:760-505-9112
Mailing Address - Fax:
Practice Address - Street 1:933 VALE TERRACE DR
Practice Address - Street 2:SUITE A
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-5213
Practice Address - Country:US
Practice Address - Phone:760-724-1011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty