Healthcare Provider Details

I. General information

NPI: 1487884268
Provider Name (Legal Business Name): DESERT DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 S VALLE VERDE DR SUITE #250
HENDERSON NV
89012-3433
US

IV. Provider business mailing address

55 S. VALLE VERDE DR. SUITE #250
HENDERSON NV
89012
US

V. Phone/Fax

Practice location:
  • Phone: 702-260-1890
  • Fax: 702-260-7936
Mailing address:
  • Phone: 702-260-1890
  • Fax: 702-260-7936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5852
License Number StateNV

VIII. Authorized Official

Name: DR. ILYA BENJAMIN
Title or Position: OWNER/DOCTOR
Credential: DMD
Phone: 702-260-1890