Healthcare Provider Details

I. General information

NPI: 1508995598
Provider Name (Legal Business Name): STAR BRITE DENTAL, HAI Q. XA D.M.D. PROF. CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 MARKS ST STE B
HENDERSON NV
89014-8602
US

IV. Provider business mailing address

560 MARKS ST STE B
HENDERSON NV
89014-8602
US

V. Phone/Fax

Practice location:
  • Phone: 702-456-5100
  • Fax: 702-456-5102
Mailing address:
  • Phone: 702-456-5100
  • Fax: 702-456-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number3780
License Number StateNV

VIII. Authorized Official

Name: HAI Q. XA
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 702-456-5100