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General NPI Number Information
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NPI Number | 1225253925
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Entity Type | Organization
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Legal Business Name | PARKWAY DENTAL
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 210 S. MARYLAND PARKWAY SUITE A
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City | LAS VEGAS
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State | NV
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Zip | 89101-5361
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Country | US
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Telephone | 702-384-3461
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Fax | 702-384-2377
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Provider Business Mailing Address
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Address Line | 210 S. MARYLAND PARKWAY SUITE A
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City | LAS VEGAS
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State | NV
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Zip | 89101-5361
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Country | US
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Telephone | 702-384-3461
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Fax | 702-384-2377
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Authorized Official
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Title or Position | DENTIST
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Name | DR. RONRICO ARCANGEL MANGAPIT
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Credential | D.M.D., P.C.
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Telephone | 702-384-3461
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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 | 4156
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License Number State | NV
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