Healthcare Provider Details

I. General information

NPI: 1790111672
Provider Name (Legal Business Name): NADIM MORAD GUIRGUIS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7125 N DURANGO DR
LAS VEGAS NV
89149-4466
US

IV. Provider business mailing address

7588 PEARL CRESCENT DR
LAS VEGAS NV
89113-3291
US

V. Phone/Fax

Practice location:
  • Phone: 702-658-2311
  • Fax:
Mailing address:
  • Phone: 702-285-2263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number61043
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-267C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: