Provider Demographics
NPI:1821199746
Name:VICTOR A. IPPOLITO DDS, INC.
Entity Type:Organization
Organization Name:VICTOR A. IPPOLITO DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:IPPOLITO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-461-7700
Mailing Address - Street 1:6280 JACKSON DRIVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-3434
Mailing Address - Country:US
Mailing Address - Phone:619-461-7700
Mailing Address - Fax:619-461-3082
Practice Address - Street 1:6280 JACKSON DR
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-3434
Practice Address - Country:US
Practice Address - Phone:619-461-7700
Practice Address - Fax:619-461-3082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA203791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty