Healthcare Provider Details

I. General information

NPI: 1154621407
Provider Name (Legal Business Name): TIBURCIO TING AND CHUNG PROF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5590 PAINTED MIRAGE RD STE. 140-150
LAS VEGAS NV
89149
US

IV. Provider business mailing address

2101 S JONES BLVD STE 140
LAS VEGAS NV
89146-3133
US

V. Phone/Fax

Practice location:
  • Phone: 702-353-4081
  • Fax: 702-947-6752
Mailing address:
  • Phone: 702-522-2269
  • Fax: 702-990-8854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: ROLAND PISCHINGER
Title or Position: INSURANCE DEPARTMENT MANAGER
Credential:
Phone: 702-522-2028