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General NPI Number Information
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NPI Number | 1083435366
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Entity Type | Organization
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Legal Business Name | HYLO PARK DENTAL PLLC
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 3880 W LAKE MEAD BLVD STE 100
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-5201
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Country | US
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Telephone | 702-626-0526
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Fax |
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Provider Business Mailing Address
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Address Line | 7380 EDNA AVE
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City | LAS VEGAS
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State | NV
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Zip | 89117-2902
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Country | US
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Telephone | 702-883-4345
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. KHURRAM FAHIM
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Credential | DMD
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Telephone | 702-883-4345
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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 |
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License Number State |
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