MEDICARE: SIRINTRA GATAN 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	122300000X	Dentist	037290	PA
2	122300000X	Dentist	5598	NV

General Provider Information

NPI Number	:	1689868762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIRINTRA GATAN DMD

Provider Business Mailing Address
First Line	:	7175 W LAKE MEAD BLVD
Second Line	:	#110
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1302
Country	:	US
Telephone Number	:	702-228-9911
Fax Number	:	702-228-9344

Provider Business Practice Location Address
First Line	:	7175 W LAKE MEAD BLVD
Second Line	:	#110
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1302
Country	:	US
Telephone Number	:	702-228-9911
Fax Number	:	702-228-9344

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

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	03/29/2010

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Directions to “ SIRINTRA GATAN DMD” Practice Location

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