Provider Demographics
NPI:1285882399
Name:WIPPERMAN, KORRI LYNN (DMD)
Entity type:Individual
Prefix:MRS
First Name:KORRI
Middle Name:LYNN
Last Name:WIPPERMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8479 PRAIRIE RUN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4021
Mailing Address - Country:US
Mailing Address - Phone:702-338-3162
Mailing Address - Fax:
Practice Address - Street 1:7260 S CIMARRON RD STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2172
Practice Address - Country:US
Practice Address - Phone:702-338-3162
Practice Address - Fax:815-550-2865
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV57321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice