Healthcare Provider Details

I. General information

NPI: 1952476285
Provider Name (Legal Business Name): ALFRED ADDISON THRESHER III DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 W FLAMINGO RD STE 102
LAS VEGAS NV
89147-5720
US

IV. Provider business mailing address

9500 W FLAMINGO RD STE 102
LAS VEGAS NV
89147-5720
US

V. Phone/Fax

Practice location:
  • Phone: 702-254-4335
  • Fax: 702-254-7995
Mailing address:
  • Phone: 702-254-4335
  • Fax: 702-254-7995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-56
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: