| NPI | 1407021678 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERNESTO HIPOLITO Dentist 702-644-4484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NV 4834T) |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2008-04-28 |