Healthcare Provider Details

I. General information

NPI: 1588678080
Provider Name (Legal Business Name): DAVID CALLISTER FIFE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 VILLAGE CENTER CIRCLE STE 110
LAS VEGAS NV
89134
US

IV. Provider business mailing address

1975 VILLAGE CENTER CIRCLE STE 110
LAS VEGAS NV
89134
US

V. Phone/Fax

Practice location:
  • Phone: 702-360-2122
  • Fax: 702-360-3963
Mailing address:
  • Phone: 702-360-2122
  • Fax: 702-360-3963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number5736
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: