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NPI Code Detail

MEDICARE: NEVADA DENTAL ESTHETICS, INC

MEDICARE: NEVADA DENTAL ESTHETICS, 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
11223G0001XGeneral Practice Dentistry2943NV

General Provider Information

NPI Number : 1891838892
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEVADA DENTAL ESTHETICS, INC
Provider Business Mailing Address
First Line : 4455 S JONES BLVD
Second Line : STE#2
City : LAS VEGAS
State : NV
Zip : 89103-3372
Country : US
Telephone Number : 702-737-3553
Fax Number : 702-873-5100
Provider Business Practice Location Address
First Line : 4455 S JONES BLVD
Second Line : STE#2
City : LAS VEGAS
State : NV
Zip : 89103-3372
Country : US
Telephone Number : 702-737-3553
Fax Number : 702-873-5100
Authorized Official
Title or Position : DDS
Name : DR. JORGE PAEZ
Credential : DDS
Telephone Number : 702-737-3553
Provider Enumeration Date : 02/15/2007
Last Update Date : 05/27/2015

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Directions to “NEVADA DENTAL ESTHETICS, INC ” Practice Location

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