Provider Demographics
NPI:1689787087
Name:HOPPER, PETER JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JAMES
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 1:1330 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-4425
Mailing Address - Country:US
Mailing Address - Phone:802-388-3553
Mailing Address - Fax:802-388-7377
Practice Address - Street 1:1330 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-4425
Practice Address - Country:US
Practice Address - Phone:802-388-3553
Practice Address - Fax:802-388-7377
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00020801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006647Medicaid