Healthcare Provider Details

I. General information

NPI: 1588454367
Provider Name (Legal Business Name): FLAMINGO RD NIELSON PDC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5680 W FLAMINGO RD STE B
LAS VEGAS NV
89103-2339
US

IV. Provider business mailing address

727 E UTAH VALLEY DR
AMERICAN FORK UT
84003-3345
US

V. Phone/Fax

Practice location:
  • Phone: 702-367-1499
  • Fax: 702-367-2531
Mailing address:
  • Phone: 801-305-3460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MARK CHRISTENSEN
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 801-305-3460