Healthcare Provider Details

I. General information

NPI: 1407021678
Provider Name (Legal Business Name): PURPLE HIPPO HIPOLITO D.D.S. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 LAS VEGAS BLVD N
LAS VEGAS NV
89115-0512
US

IV. Provider business mailing address

4333 LAS VEGAS BLVD N
LAS VEGAS NV
89115-0512
US

V. Phone/Fax

Practice location:
  • Phone: 702-644-4484
  • Fax: 702-643-4384
Mailing address:
  • Phone: 702-644-4484
  • Fax: 702-643-4384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number4834T
License Number StateNV

VIII. Authorized Official

Name: DR. ERNESTO HIPOLITO
Title or Position: DENTIST
Credential: D.M.D
Phone: 702-644-4484