Provider Demographics
NPI:1215090873
Name:HIPOLITO, MICHAEL REY (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:REY
Last Name:HIPOLITO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:405 FREDERICK RD
Mailing Address - Street 2:SUITE #108
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228
Mailing Address - Country:US
Mailing Address - Phone:410-747-7495
Mailing Address - Fax:410-747-7699
Practice Address - Street 1:405 FREDERICK RD
Practice Address - Street 2:SUITE #108
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228
Practice Address - Country:US
Practice Address - Phone:410-747-7495
Practice Address - Fax:410-747-7699
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD117531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice