Provider Demographics
NPI:1750473377
Name:HOPPER, PHILLIP LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:LAWRENCE
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 1:5757 W THUNDERBIRD RD
Mailing Address - Street 2:STE W304
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306
Mailing Address - Country:US
Mailing Address - Phone:602-938-2736
Mailing Address - Fax:602-938-3783
Practice Address - Street 1:5757 W THUNDERBIRD RD
Practice Address - Street 2:STE W304
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306
Practice Address - Country:US
Practice Address - Phone:602-938-2736
Practice Address - Fax:602-938-3783
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3127122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist