Provider Demographics
NPI:1407021678
Name:PURPLE HIPPO HIPOLITO D.D.S. P.C.
Entity Type:Organization
Organization Name:PURPLE HIPPO HIPOLITO D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:HIPOLITO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-644-4484
Mailing Address - Street 1:4333 LAS VEGAS BLVD N
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-0512
Mailing Address - Country:US
Mailing Address - Phone:702-644-4484
Mailing Address - Fax:702-643-4384
Practice Address - Street 1:4333 LAS VEGAS BLVD N
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-0512
Practice Address - Country:US
Practice Address - Phone:702-644-4484
Practice Address - Fax:702-643-4384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4834T302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization