Provider Demographics
NPI:1891838207
Name:HOOKER, JOHN WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WAYNE
Last Name:HOOKER
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:PO BOX 2045
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212-2045
Mailing Address - Country:US
Mailing Address - Phone:276-628-9507
Mailing Address - Fax:276-628-9439
Practice Address - Street 1:915 W MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2481
Practice Address - Country:US
Practice Address - Phone:276-628-9507
Practice Address - Fax:276-628-9439
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC54981223G0001X
VA0401414395332B00000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies