Healthcare Provider Details

I. General information

NPI: 1912924820
Provider Name (Legal Business Name): ADAVEN CHILDRENS DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N GREEN VALLEY PARKWAY #8E
HENDERSON NV
89074
US

IV. Provider business mailing address

1701 N GREEN VALLEY PARKWAY #8E
HENDERSON NV
89074
US

V. Phone/Fax

Practice location:
  • Phone: 702-492-1955
  • Fax: 702-492-7663
Mailing address:
  • Phone: 702-492-1955
  • Fax: 702-492-7663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. MANNY RAPP
Title or Position: OWNER PEREODONTIST
Credential: DDS
Phone: 702-492-1955