Provider Demographics
NPI:1467460592
Name:HOPPER, GARY RICHARD (DDS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:RICHARD
Last Name:HOPPER
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 1:1102 E MORTON PL
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4540
Mailing Address - Country:US
Mailing Address - Phone:951-925-2318
Mailing Address - Fax:951-652-9553
Practice Address - Street 1:1102 E MORTON PL
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4540
Practice Address - Country:US
Practice Address - Phone:951-925-2318
Practice Address - Fax:951-652-9553
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24801122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist