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General NPI Number Information
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NPI Number | 1023263365
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Entity Type | Organization
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Legal Business Name | MRDNTD LLC
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Dates
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Enumeration Date | 12/01/2008
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Last Update Date | 01/19/2011
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Provider Practice Location Address
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Address Line | 3575 S. TOWN CENTER DR. SUITE 120
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City | LAS VEGAS
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State | NV
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Zip | 89135
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Country | US
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Telephone | 702-869-5700
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Fax | 702-869-6657
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Provider Business Mailing Address
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Address Line | 3575 S. TOWN CENTER DR. #120
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City | LAS VEGAS
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State | NV
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Zip | 89135
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Country | US
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Telephone | 702-869-5700
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Fax | 702-869-6657
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Authorized Official
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Title or Position | MANAGER
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Name | PROF. JOHN SOUMI
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Credential | DDS
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Telephone | 702-869-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3502
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License Number State | NV
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