Provider Demographics
NPI:1982614624
Name:HOOPER, RAYMON ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMON
Middle Name:ALLEN
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 1:1420 W SOUTHWEST LOOP 323
Mailing Address - Street 2:SUITE #4
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-9347
Mailing Address - Country:US
Mailing Address - Phone:903-561-9535
Mailing Address - Fax:903-561-5354
Practice Address - Street 1:1420 W SOUTHWEST LOOP 323
Practice Address - Street 2:SUITE #4
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-9347
Practice Address - Country:US
Practice Address - Phone:903-561-9535
Practice Address - Fax:903-561-5354
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice