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NPI Code Detail

MEDICARE: MUGLESTON GREEN VALLEY MODERN DENTISTRY, PC

MEDICARE: MUGLESTON GREEN VALLEY MODERN DENTISTRY, PC
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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1740650118
Entity Type Code : Organization
Provider Name (Legal Business Name) : MUGLESTON GREEN VALLEY MODERN DENTISTRY, PC
Provider Business Mailing Address
First Line : 17000 RED HILL AVE
Second Line :
City : IRVINE
State : CA
Zip : 92614-5626
Country : US
Telephone Number : 714-845-8890
Fax Number : 949-474-1495
Provider Business Practice Location Address
First Line : 4301 E SUNSET RD
Second Line : 100
City : HENDERSON
State : NV
Zip : 89014-2238
Country : US
Telephone Number : 702-465-8187
Fax Number : 702-558-9278
Authorized Official
Title or Position : OWNER DENTIST
Name : DR. CODY P MUGLESTON
Credential : DMD
Telephone Number : 702-465-8187
Provider Enumeration Date : 09/29/2015
Last Update Date : 09/29/2015

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Directions to “MUGLESTON GREEN VALLEY MODERN DENTISTRY, PC ” Practice Location

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