Provider Demographics
NPI:1861588857
Name:HOEPPNER, TODD ROGER (DDS, PC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:ROGER
Last Name:HOEPPNER
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5405
Mailing Address - Country:US
Mailing Address - Phone:641-424-0060
Mailing Address - Fax:
Practice Address - Street 1:615 S ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-5405
Practice Address - Country:US
Practice Address - Phone:641-424-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080281223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0231720Medicaid