MEDICARE: HILLCREST DENTAL

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	261QD0000X	Dental Clinic/Center		NV

General Provider Information

NPI Number	:	1245448836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILLCREST DENTAL

Provider Business Mailing Address
First Line	:	3350 NOVAT ST STE 145
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129
Country	:	US
Telephone Number	:	702-395-1088
Fax Number	:	702-395-0888

Provider Business Practice Location Address
First Line	:	3350 NOVAT ST STE 145
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129
Country	:	US
Telephone Number	:	702-395-1088
Fax Number	:	702-395-0888

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TONY CHING KOU LEE
Credential	:	D.M.D
Telephone Number	:	702-257-6767

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	07/21/2022

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Directions to “HILLCREST DENTAL ” Practice Location

Language	Start Address	Practice Location

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