Healthcare Provider Details

I. General information

NPI: 1649360306
Provider Name (Legal Business Name): PATRICIA PRADA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 W CHEYENNE AVE 104
LAS VEGAS NV
89129-8405
US

IV. Provider business mailing address

2250 S. RANCHO DR. STE. 205
LAS VEGAS NV
89102
US

V. Phone/Fax

Practice location:
  • Phone: 702-733-0888
  • Fax: 702-395-8718
Mailing address:
  • Phone: 702-291-2031
  • Fax: 702-984-7566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberS6-33C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: