MEDICARE: DILETTANTE INC.

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	4348	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760795256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DILETTANTE INC.

Provider Business Mailing Address
First Line	:	5465 SIMMONS ST
Second Line	:	SUITE 4
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-9000
Country	:	US
Telephone Number	:	702-638-1005
Fax Number	:	702-638-1071

Provider Business Practice Location Address
First Line	:	5465 SIMMONS ST
Second Line	:	SUITE 4
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-9000
Country	:	US
Telephone Number	:	702-638-1005
Fax Number	:	702-638-1071

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	PAMELA K PROPSTER
Credential	:
Telephone Number	:	702-638-1005

Provider Enumeration Date	:	07/26/2010
Last Update Date	:	07/26/2010

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Directions to “DILETTANTE INC. ” Practice Location

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