Provider Demographics
NPI:1518073352
Name:HIPP, LEROY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEROY
Middle Name:M
Last Name:HIPP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 SIBLEY STREET
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2975
Mailing Address - Country:US
Mailing Address - Phone:651-224-9300
Mailing Address - Fax:651-224-3226
Practice Address - Street 1:405 SIBLEY ST
Practice Address - Street 2:SUITE 240
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2975
Practice Address - Country:US
Practice Address - Phone:651-224-9300
Practice Address - Fax:651-224-3226
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN80661223G0001X
MND121021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice