MEDICARE: DR. GUY LANDRY TATSUO CHISTECKOFF D.D.S.

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	3706	NV

General Provider Information

NPI Number	:	1063528016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUY LANDRY TATSUO CHISTECKOFF D.D.S.

Provider Business Mailing Address
First Line	:	8940 S MARYLAND PWKY
Second Line	:	100
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-5363
Country	:	US
Telephone Number	:	702-270-6501
Fax Number	:	702-260-4249

Provider Business Practice Location Address
First Line	:	8940 S MARYLAND PWKY
Second Line	:	100
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-5363
Country	:	US
Telephone Number	:	702-270-6501
Fax Number	:	702-260-4249

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/08/2007

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