Provider Demographics
NPI:1023719002
Name:HOOPER, JAKE (DDS)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:
Last Name:HOOPER
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 1:3030 LYNDON B JOHNSON FWY STE 1700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-2759
Mailing Address - Country:US
Mailing Address - Phone:855-463-1759
Mailing Address - Fax:
Practice Address - Street 1:3030 LYNDON B JOHNSON FWY STE 1700
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-2759
Practice Address - Country:US
Practice Address - Phone:855-463-1759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX406191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice