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General NPI Number Information
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NPI Number | 1083735245
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Entity Type | Organization
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Legal Business Name | COSMOPOLITAN DENTAL
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 1301 BERTHA HOWE AVE SUITE 5
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City | MESQUITE
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State | NV
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Zip | 89027-7502
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Country | US
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Telephone | 702-345-2299
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Fax | 702-345-2303
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Provider Business Mailing Address
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Address Line | PO BOX 2608
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City | MESQUITE
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State | NV
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Zip | 89024-2608
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Country | US
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Telephone | 702-345-2299
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Fax | 702-345-2303
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Authorized Official
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Title or Position | OWNER
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Name | THERESA R WOOLRIDGE-OFORI
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Credential | DDS
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Telephone | 702-345-2299
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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 | 4669
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License Number State | NV
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