Healthcare Provider Details

I. General information

NPI: 1497996219
Provider Name (Legal Business Name): CHILDREN'S DENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 VILLAGE CENTER CIR SUITE 120
LAS VEGAS NV
89134-6262
US

IV. Provider business mailing address

2085 VILLAGE CENTER CIR SUITE 120
LAS VEGAS NV
89134-6262
US

V. Phone/Fax

Practice location:
  • Phone: 702-240-5437
  • Fax: 702-240-5436
Mailing address:
  • Phone: 702-240-5437
  • Fax: 702-240-5436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberS644
License Number StateNV

VIII. Authorized Official

Name: DR. TODD S MILNE
Title or Position: OWNER/PROVIDER
Credential: D.D.S.
Phone: 702-240-5437