Healthcare Provider Details

I. General information

NPI: 1639801236
Provider Name (Legal Business Name): D. A. CHENIN, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 VILLAGE CENTER CIR STE 110
LAS VEGAS NV
89134-6259
US

IV. Provider business mailing address

1945 VILLAGE CENTER CIR STE 110
LAS VEGAS NV
89134-6259
US

V. Phone/Fax

Practice location:
  • Phone: 702-364-5100
  • Fax:
Mailing address:
  • Phone: 702-364-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID ALAN CHENIN
Title or Position: MANAGER
Credential: DDS, MSD
Phone: 702-524-6041