Healthcare Provider Details

I. General information

NPI: 1013013283
Provider Name (Legal Business Name): POINTE NORTH DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7312 W CHEYENNE AVE SUITE 3
LAS VEGAS NV
89129-7428
US

IV. Provider business mailing address

7312 W CHEYENNE AVE SUITE 3
LAS VEGAS NV
89129-7428
US

V. Phone/Fax

Practice location:
  • Phone: 702-396-9924
  • Fax: 702-396-3735
Mailing address:
  • Phone: 702-396-9924
  • Fax: 702-396-3735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number3336
License Number StateNV

VIII. Authorized Official

Name: MISS TRACY MOORE
Title or Position: OFFICE MANAGER
Credential:
Phone: 702-396-9924