MEDICARE: NANTIYA JOE LIMITED

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	3225	NV

General Provider Information

NPI Number	:	1225163959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NANTIYA JOE LIMITED

Provider Business Mailing Address
First Line	:	9155 W FLAMINGO RD
Second Line	:	120
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-6894
Country	:	US
Telephone Number	:	702-838-8112
Fax Number	:	702-838-1907

Provider Business Practice Location Address
First Line	:	9155 W FLAMINGO RD
Second Line	:	120
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-6894
Country	:	US
Telephone Number	:	702-838-8112
Fax Number	:	702-838-1907

Authorized Official
Title or Position	:	OWNER
Name	:	MS. NANTIYA H JOE
Credential	:	D.D.S, M.S.
Telephone Number	:	702-838-8112

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	08/22/2020

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Directions to “NANTIYA JOE LIMITED ” Practice Location

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