Provider Demographics
NPI:1770798118
Name:HOOPS, BRIAN (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:HOOPS
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 1:71 BROADWAY STREET
Mailing Address - Street 2:P.O. BOX 219
Mailing Address - City:BAILEYVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04694-0219
Mailing Address - Country:US
Mailing Address - Phone:207-427-6064
Mailing Address - Fax:
Practice Address - Street 1:71 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAILEYVILLE
Practice Address - State:ME
Practice Address - Zip Code:04694-0219
Practice Address - Country:US
Practice Address - Phone:207-427-6064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2009-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3271122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME131110000Medicaid