Healthcare Provider Details

I. General information

NPI: 1619121159
Provider Name (Legal Business Name): DURANGO ORTHODONTICS, LLLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 S DURANGO DR SUITE 100
LAS VEGAS NV
89113-1785
US

IV. Provider business mailing address

PO BOX 400760
LAS VEGAS NV
89140-0760
US

V. Phone/Fax

Practice location:
  • Phone: 702-750-2400
  • Fax: 702-750-2401
Mailing address:
  • Phone: 702-750-2400
  • Fax: 702-750-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-138
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-166
License Number StateNV

VIII. Authorized Official

Name: DR. JAMES K MAH
Title or Position: PARTNER
Credential: DDS, MSC, MRCD(C), D
Phone: 702-750-2400