MEDICARE: RESIDENTAL NV LLC

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

General Provider Information

NPI Number	:	1447189014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESIDENTAL NV LLC

Provider Business Mailing Address
First Line	:	11225 EMERALD PINE LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-1589
Country	:	US
Telephone Number	:	801-300-5067
Fax Number	:

Provider Business Practice Location Address
First Line	:	11225 EMERALD PINE LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-1589
Country	:	US
Telephone Number	:	801-300-5067
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SLOAN ROBISON
Credential	:	DMD
Telephone Number	:	801-300-5067

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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Directions to “RESIDENTAL NV LLC ” Practice Location

Language	Start Address	Practice Location

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