Healthcare Provider Details

I. General information

NPI: 1841461597
Provider Name (Legal Business Name): SOUTHERN HILLS ORTHODONTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6460 MEDICAL CENTER ST SUITE 210
LAS VEGAS NV
89148-2421
US

IV. Provider business mailing address

6460 MEDICAL CENTER ST SUITE 210
LAS VEGAS NV
89148-2421
US

V. Phone/Fax

Practice location:
  • Phone: 702-798-6020
  • Fax: 702-798-6024
Mailing address:
  • Phone: 702-798-6020
  • Fax: 702-798-6024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2496/S3-42
License Number StateNV

VIII. Authorized Official

Name: DR. RICHARD M STEVENS
Title or Position: DIRECTOR
Credential: DMD
Phone: 702-798-6020