Healthcare Provider Details

I. General information

NPI: 1710406186
Provider Name (Legal Business Name): MUNEHIKO RO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 W HORIZON RIDGE PKWY STE 202
HENDERSON NV
89052-2870
US

IV. Provider business mailing address

2610 W HORIZON RIDGE PKWY STE 202
HENDERSON NV
89052-2870
US

V. Phone/Fax

Practice location:
  • Phone: 702-270-4600
  • Fax: 702-270-7773
Mailing address:
  • Phone: 702-270-4600
  • Fax: 702-270-7773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberS4-104C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: