Provider Demographics
NPI:1922446673
Name:HOPEN, JACLYN RICKOFF (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:RICKOFF
Last Name:HOPEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JACLYN
Other - Middle Name:MARIE
Other - Last Name:RICKOFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1980 E 116TH ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3599
Mailing Address - Country:US
Mailing Address - Phone:317-848-1771
Mailing Address - Fax:
Practice Address - Street 1:1980 E 116TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3599
Practice Address - Country:US
Practice Address - Phone:317-848-1771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011976A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice