Provider Demographics
NPI:1902916158
Name:HOPKINS, JERRY L (DMD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:L
Last Name:HOPKINS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13056 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-3039
Mailing Address - Country:US
Mailing Address - Phone:503-760-1341
Mailing Address - Fax:503-760-8058
Practice Address - Street 1:13056 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-3039
Practice Address - Country:US
Practice Address - Phone:503-760-1341
Practice Address - Fax:503-760-8058
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD5336122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist