MEDICARE: PARADISE DENTAL CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1223G0001X	General Practice Dentistry
2	1223P0221X	Pediatric Dentistry
3	122300000X	Dentist

General Provider Information

NPI Number	:	1891085684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARADISE DENTAL CLINIC

Provider Business Mailing Address
First Line	:	1750 WHEELER PEAK DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2150
Country	:	US
Telephone Number	:	702-272-1100
Fax Number	:	702-998-0675

Provider Business Practice Location Address
First Line	:	1750 WHEELER PEAK DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2150
Country	:	US
Telephone Number	:	702-272-1100
Fax Number	:	702-998-0675

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. ELIZABETH RAZO
Credential	:	ADMINISTRATION
Telephone Number	:	702-272-1100

Provider Enumeration Date	:	04/13/2011
Last Update Date	:	04/13/2011

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Directions to “PARADISE DENTAL CLINIC ” Practice Location

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