Provider Demographics
NPI:1881673556
Name:HOPP, DENNIS WILLIAM
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:WILLIAM
Last Name:HOPP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-9004
Mailing Address - Country:US
Mailing Address - Phone:712-329-9419
Mailing Address - Fax:712-329-0329
Practice Address - Street 1:201 W BROADWAY
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-9004
Practice Address - Country:US
Practice Address - Phone:712-329-9419
Practice Address - Fax:712-329-0329
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01422174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0263582Medicaid
IAI5958Medicare ID - Type Unspecified