Healthcare Provider Details

I. General information

NPI: 1467220335
Provider Name (Legal Business Name): TRUMAN AND DOUGHERTY ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W SAHARA AVE STE 110
LAS VEGAS NV
89117-6072
US

IV. Provider business mailing address

10000 W SAHARA AVE STE 110
LAS VEGAS NV
89117-6072
US

V. Phone/Fax

Practice location:
  • Phone: 702-360-9000
  • Fax: 702-320-9045
Mailing address:
  • Phone: 702-360-9000
  • Fax: 702-320-9045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KELSEY WILLMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 702-360-9000