Healthcare Provider Details

I. General information

NPI: 1548607294
Provider Name (Legal Business Name): DOCTORS BILL AND DAVIS DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10660 SOUTHERN HIGHLANDS PKWY SUITE 110
LAS VEGAS NV
89141-4114
US

IV. Provider business mailing address

10660 SOUTHERN HIGHLANDS PKWY SUITE #110
LAS VEGAS NV
89141-4114
US

V. Phone/Fax

Practice location:
  • Phone: 702-477-0040
  • Fax:
Mailing address:
  • Phone: 702-477-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberS6-121
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-233
License Number StateNV

VIII. Authorized Official

Name: JAY E DAVIS
Title or Position: MANAGING MEMBER
Credential: DMD, MS
Phone: 702-477-0040