Healthcare Provider Details

I. General information

NPI: 1235249822
Provider Name (Legal Business Name): KIKI S DOUNIS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 RANCHO LN 270
LAS VEGAS NV
89106-3836
US

IV. Provider business mailing address

512 TUSCANY VIEW ST
LAS VEGAS NV
89145-4876
US

V. Phone/Fax

Practice location:
  • Phone: 702-636-3060
  • Fax:
Mailing address:
  • Phone: 702-233-0782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number3495015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: