Healthcare Provider Details

I. General information

NPI: 1588963615
Provider Name (Legal Business Name): FUTURE SMILES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3074 ARVILLE ST
LAS VEGAS NV
89102-7490
US

IV. Provider business mailing address

3074 ARVILLE ST
LAS VEGAS NV
89102-7490
US

V. Phone/Fax

Practice location:
  • Phone: 702-889-3763
  • Fax:
Mailing address:
  • Phone: 702-889-3763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3419
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3636
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3626
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number10099
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number101718
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2713
License Number StateNV
# 7
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number4380
License Number StateNV
# 8
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number4447
License Number StateNV
# 9
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3646
License Number StateNV
# 10
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3420
License Number StateNV

VIII. Authorized Official

Name: MRS. MARY TERESA CHANDLER
Title or Position: EXECUTIVE DIRECTOR
Credential: RDH
Phone: 702-889-3763