Healthcare Provider Details

I. General information

NPI: 1447576665
Provider Name (Legal Business Name): DENTAL NATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E DESERT INN RD STE #3
LAS VEGAS NV
89169-2550
US

IV. Provider business mailing address

1500 E DESERT INN RD STE #3
LAS VEGAS NV
89169-2550
US

V. Phone/Fax

Practice location:
  • Phone: 702-642-8101
  • Fax: 702-642-1131
Mailing address:
  • Phone: 702-642-8101
  • Fax: 702-642-1131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: DR. KLINE C BLACK
Title or Position: PRESIDENT
Credential: DMD
Phone: 702-642-8101