Provider Demographics
NPI:1427132117
Name:MILLHOPPER FAMILY DENTISTRY PA
Entity type:Organization
Organization Name:MILLHOPPER FAMILY DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KNOPF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-377-1705
Mailing Address - Street 1:3510 NW 43RD STREET
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6104
Mailing Address - Country:US
Mailing Address - Phone:352-377-1705
Mailing Address - Fax:352-377-1093
Practice Address - Street 1:3510 NW 43RD STREET
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6104
Practice Address - Country:US
Practice Address - Phone:352-377-1705
Practice Address - Fax:352-377-1093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18867122300000X
FLDN19319122300000X
FLDN0088051223G0001X
FLDN171101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty