Provider Demographics
NPI:1801813514
Name:HIPONA, CARMEN T (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:T
Last Name:HIPONA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 CUNNINGHAM LAKE CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-1246
Mailing Address - Country:US
Mailing Address - Phone:408-532-9111
Mailing Address - Fax:
Practice Address - Street 1:2721 ABORN RD
Practice Address - Street 2:SUITE #20
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1280
Practice Address - Country:US
Practice Address - Phone:408-532-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA436991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice