Provider Demographics
NPI:1790910693
Name:HOPKINS, CARSON TERRY (DMD)
Entity Type:Individual
Prefix:
First Name:CARSON
Middle Name:TERRY
Last Name:HOPKINS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124-2605
Mailing Address - Country:US
Mailing Address - Phone:620-672-3612
Mailing Address - Fax:620-672-3314
Practice Address - Street 1:105 W 4TH ST
Practice Address - Street 2:
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124-2605
Practice Address - Country:US
Practice Address - Phone:620-672-3612
Practice Address - Fax:620-672-3314
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS606341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice