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General NPI Number Information
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NPI Number | 1063309755
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Entity Type | Organization
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Legal Business Name | SHADOW CREEK CHILDREN'S DENTISTRY AND ORTHODONTICS GENERAL PARTNERSHIP
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 3410 E CENTENNIAL PKWY STE 110
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89081-5627
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Country | US
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Telephone | 702-701-2563
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Fax |
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Provider Business Mailing Address
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Address Line | 3196 S MARYLAND PKWY STE 307
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City | LAS VEGAS
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State | NV
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Zip | 89109-2314
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | RYAN JOLLEY
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Credential |
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Telephone | 702-701-2563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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