MEDICARE: EASTERN HILLS DENTAL 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	122300000X	Dentist

General Provider Information

NPI Number	:	1770930612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN HILLS DENTAL LLC

Provider Business Mailing Address
First Line	:	3350 NOVAT ST STE 145
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8722
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5905 S EASTERN AVE STE 112
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-3130
Country	:	US
Telephone Number	:	702-395-1088
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. TRACEY MCDOINALD
Credential	:
Telephone Number	:	702-395-1088

Provider Enumeration Date	:	05/20/2016
Last Update Date	:	05/20/2016

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Directions to “EASTERN HILLS DENTAL LLC ” Practice Location

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