Provider Demographics
NPI:1275697203
Name:HOOPER, STEPHEN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:HOOPER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 DOUGLAS DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3497
Mailing Address - Country:US
Mailing Address - Phone:318-742-2272
Mailing Address - Fax:318-742-2975
Practice Address - Street 1:2710 DOUGLAS DR
Practice Address - Street 2:SUITE C
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3497
Practice Address - Country:US
Practice Address - Phone:318-742-2272
Practice Address - Fax:318-742-2975
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA41931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA804528OtherUNITED CONCORDIA
LAG8212OtherBLUE CROSS BLUE SHIELD LA