Provider Demographics
NPI:1669654109
Name:HOPSON, CLYDE EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:EDWARD
Last Name:HOPSON
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 1:20 RENAE DR
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-3582
Mailing Address - Country:US
Mailing Address - Phone:530-257-0853
Mailing Address - Fax:
Practice Address - Street 1:475-750 RICE CANYON ROAD
Practice Address - Street 2:HDSP
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130
Practice Address - Country:US
Practice Address - Phone:530-251-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA540491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice