Healthcare Provider Details

I. General information

NPI: 1235269838
Provider Name (Legal Business Name): RICHARD ALAN MECALL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2327 GREEN MOUNTAIN CT
LAS VEGAS NV
89135-1536
US

IV. Provider business mailing address

2327 GREEN MOUNTAIN CT
LAS VEGAS NV
89135-1536
US

V. Phone/Fax

Practice location:
  • Phone: 702-204-4455
  • Fax: 702-562-0711
Mailing address:
  • Phone: 702-204-4455
  • Fax: 702-562-0711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberS4-23
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: