Healthcare Provider Details

I. General information

NPI: 1821985383
Provider Name (Legal Business Name): RED ROCK DENTAL ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 SAINT ROSE PKWY UNIT 777112
HENDERSON NV
89077-8805
US

IV. Provider business mailing address

3055 SAINT ROSE PKWY UNIT 777112
HENDERSON NV
89077-8805
US

V. Phone/Fax

Practice location:
  • Phone: 702-553-6762
  • Fax: 855-655-4767
Mailing address:
  • Phone: 702-553-6762
  • Fax: 855-655-4767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY THEODORE ROBERTS
Title or Position: OWNER
Credential: DMD
Phone: 702-553-6762