Provider Demographics
NPI:1376689646
Name:HOPKINS, TIMOTHY TED (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:TED
Last Name:HOPKINS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 FALLS AVE
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3314
Mailing Address - Country:US
Mailing Address - Phone:208-733-1182
Mailing Address - Fax:208-733-3341
Practice Address - Street 1:590 FALLS AVE
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3314
Practice Address - Country:US
Practice Address - Phone:208-733-1182
Practice Address - Fax:208-733-3341
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3944-OS1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010157302OtherBLUE SHIELD OF IDAHO
ID807501100Medicaid
ID6P081OtherBLUE CROSS MEDICAL
ID6P082OtherBLUE CROSS DENTAL
ID807513800Medicaid