Healthcare Provider Details

I. General information

NPI: 1295996627
Provider Name (Legal Business Name): RYAN SCOTT GIFFORD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 W CHARLESTON BLVD #201
LAS VEGAS NV
89102-1846
US

IV. Provider business mailing address

3811 W CHARLESTON BLVD #201
LAS VEGAS NV
89102-1846
US

V. Phone/Fax

Practice location:
  • Phone: 702-259-1943
  • Fax: 702-877-2727
Mailing address:
  • Phone: 702-259-1943
  • Fax: 702-877-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number5103/S4-48
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: