MEDICARE: DR. DAVID ELEAZER SOMOZA-VALLE DMD

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	7615	NV

General Provider Information

NPI Number	:	1578118758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ELEAZER SOMOZA-VALLE DMD

Provider Business Mailing Address
First Line	:	3574 DESERT CLIFF ST UNIT 203
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8673
Country	:	US
Telephone Number	:	305-384-0161
Fax Number	:

Provider Business Practice Location Address
First Line	:	6485 N DECATUR BLVD STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-2989
Country	:	US
Telephone Number	:	702-577-1941
Fax Number	:	702-832-1495

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

Provider Enumeration Date	:	08/05/2019
Last Update Date	:	04/29/2022

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