Provider Demographics
NPI:1790018703
Name:BRIAN T. HOOPS, D.D.S. , P.A.
Entity Type:Organization
Organization Name:BRIAN T. HOOPS, D.D.S. , P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-427-6064
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:BAILEYVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04694-0219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:71 BROADWAY STREET
Practice Address - Street 2:
Practice Address - City:BAILEYVILLE
Practice Address - State:ME
Practice Address - Zip Code:04694
Practice Address - Country:US
Practice Address - Phone:207-427-6064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME131110000Medicaid