Provider Demographics
NPI:1376827832
Name:DUSTIN J HOPKIN DDS, ORAL AND MAXILLOFACIAL SURGERY P.C.
Entity Type:Organization
Organization Name:DUSTIN J HOPKIN DDS, ORAL AND MAXILLOFACIAL SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HOPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-277-3942
Mailing Address - Street 1:2180 E 4500 S STE 285
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4028
Mailing Address - Country:US
Mailing Address - Phone:801-277-3942
Mailing Address - Fax:801-277-4505
Practice Address - Street 1:2180 E 4500 S STE 285
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4028
Practice Address - Country:US
Practice Address - Phone:801-277-3942
Practice Address - Fax:801-277-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-03
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7752965261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery