Provider Demographics
NPI:1376532770
Name:HOOPER, CLIFFORD BRIAN (DDS)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:BRIAN
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 1:520 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3615
Mailing Address - Country:US
Mailing Address - Phone:405-341-1835
Mailing Address - Fax:405-341-8291
Practice Address - Street 1:520 W 15TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3615
Practice Address - Country:US
Practice Address - Phone:405-341-1835
Practice Address - Fax:405-341-8291
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK45211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice