Provider Demographics
NPI:1770678807
Name:HOPKINS, KENNETH MARCUS (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MARCUS
Last Name:HOPKINS
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 1:2136 EXETER RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3922
Mailing Address - Country:US
Mailing Address - Phone:901-754-8002
Mailing Address - Fax:901-759-9113
Practice Address - Street 1:2136 EXETER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3922
Practice Address - Country:US
Practice Address - Phone:901-754-8002
Practice Address - Fax:901-759-9113
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN70891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU66623Medicare UPIN
TN3226060Medicare ID - Type Unspecified