Healthcare Provider Details

I. General information

NPI: 1104456557
Provider Name (Legal Business Name): BEAUTI' DEN CROWN RESTORATION CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 S MARYLAND PKWY # 503
LAS VEGAS NV
89183-7146
US

IV. Provider business mailing address

9850 S MARYLAND PKWY # 503
LAS VEGAS NV
89183-7146
US

V. Phone/Fax

Practice location:
  • Phone: 702-351-0502
  • Fax:
Mailing address:
  • Phone: 702-351-0502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL

VIII. Authorized Official

Name: PATTI PENNINGTON
Title or Position: PRESIDENT
Credential:
Phone: 702-351-0502