Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 5159 | NE |
NPI | 1053687947 |
---|---|
Provider Name | Dr. Bradley Jay Hoppens |
First Address | Ogallala, NE 69153-2564 |
Second Address | Ogallala, NE 69153-2564 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2012 |
Last Update Date | 26/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
470683740 | (05) | NE |