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General NPI Number Information
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NPI Number | 1225058746
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Entity Type | Organization
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Legal Business Name | JAMES R DETTLING MD
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 05/21/2015
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Provider Practice Location Address
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Address Line | 801 S RANCHO DR STE F2
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City | LAS VEGAS
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State | NV
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Zip | 89106-3814
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Country | US
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Telephone | 702-877-6781
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Fax |
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Provider Business Mailing Address
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Address Line | 801 S RANCHO DR STE F2
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City | LAS VEGAS
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State | NV
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Zip | 89106-3814
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Country | US
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Telephone | 702-877-6781
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DIANNE SVIDERSKI
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Credential |
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Telephone | 702-877-6781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | NV8925
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License Number State | NV
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