Provider Demographics
NPI:1144603077
Name:HIPP, EVAN (DMD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:HIPP
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 1:301 E PLUM ST
Mailing Address - Street 2:
Mailing Address - City:HAUBSTADT
Mailing Address - State:IN
Mailing Address - Zip Code:47639-8208
Mailing Address - Country:US
Mailing Address - Phone:812-768-6700
Mailing Address - Fax:
Practice Address - Street 1:301 E PLUM ST
Practice Address - Street 2:
Practice Address - City:HAUBSTADT
Practice Address - State:IN
Practice Address - Zip Code:47639-8208
Practice Address - Country:US
Practice Address - Phone:812-768-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012352A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist