Provider Demographics
NPI:1629282587
Name:HIPP, MICHAEL STEWART (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEWART
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 1:4231 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-3496
Mailing Address - Country:US
Mailing Address - Phone:515-274-2511
Mailing Address - Fax:515-234-1206
Practice Address - Street 1:4231 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311-3496
Practice Address - Country:US
Practice Address - Phone:515-274-2511
Practice Address - Fax:515-234-1206
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA66541223X0400X
NC46481223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0185256Medicaid