Healthcare Provider Details

I. General information

NPI: 1902091267
Provider Name (Legal Business Name): KIM THANH MAI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 ARROYO CROSSING PKWY STE 100
LAS VEGAS NV
89113-4068
US

IV. Provider business mailing address

7300 ARROYO CROSSING PKWY STE 100
LAS VEGAS NV
89113-4068
US

V. Phone/Fax

Practice location:
  • Phone: 702-656-7846
  • Fax:
Mailing address:
  • Phone: 702-656-7846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-155
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: