MEDICARE: MRS. KORRI LYNN WIPPERMAN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5732	NV

General Provider Information

NPI Number	:	1285882399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KORRI LYNN WIPPERMAN DMD

Provider Business Mailing Address
First Line	:	8479 PRAIRIE RUN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4021
Country	:	US
Telephone Number	:	702-338-3162
Fax Number	:

Provider Business Practice Location Address
First Line	:	7260 S CIMARRON RD STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2172
Country	:	US
Telephone Number	:	702-338-3162
Fax Number	:	815-550-2865

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	11/06/2018

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