Provider Demographics
NPI:1205032414
Name:HIPOLITO, ERNESTO REY (DMD)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:REY
Last Name:HIPOLITO
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 1:9101 W SAHARA AVE
Mailing Address - Street 2:SUITE 105-166
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5772
Mailing Address - Country:US
Mailing Address - Phone:702-655-3354
Mailing Address - Fax:702-228-6525
Practice Address - Street 1:9101 W SAHARA AVE
Practice Address - Street 2:SUITE 105-166
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5772
Practice Address - Country:US
Practice Address - Phone:702-622-3354
Practice Address - Fax:702-228-6525
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV48341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice