MEDICARE: PERFECT SMILE 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1871357111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFECT SMILE LLC

Provider Business Mailing Address
First Line	:	10020 SCARLET HILLS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-7017
Country	:	US
Telephone Number	:	725-244-5512
Fax Number	:

Provider Business Practice Location Address
First Line	:	298 E ANN RD STE 101
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2903
Country	:	US
Telephone Number	:	702-936-4011
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MATTHEW MANAS
Credential	:
Telephone Number	:	725-244-5512

Provider Enumeration Date	:	02/07/2024
Last Update Date	:	07/01/2026

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