Healthcare Provider Details

I. General information

NPI: 1821623059
Provider Name (Legal Business Name): YIP HORIZON RIDGE MODERN DENTISTRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10525 S EASTERN AVE STE 100
HENDERSON NV
89052-3971
US

IV. Provider business mailing address

17000 RED HILL AVE
IRVINE CA
92614-5626
US

V. Phone/Fax

Practice location:
  • Phone: 702-508-0906
  • Fax:
Mailing address:
  • Phone: 714-845-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MANDY YIP
Title or Position: OWNER
Credential:
Phone: 714-845-8500