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General NPI Number Information
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NPI Number | 1225513732
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Entity Type | Organization
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Legal Business Name | THE DENTAL DIFFERENCE LLC
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Dates
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Enumeration Date | 10/01/2018
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Last Update Date | 10/01/2018
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Provider Practice Location Address
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Address Line | 1264 S NELLIS BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89104-5782
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Country | US
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Telephone | 702-998-7400
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Fax | 702-944-7970
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Provider Business Mailing Address
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Address Line | 1264 S NELLIS BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89104-5782
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Country | US
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Telephone | 702-998-7400
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Fax | 702-944-7970
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Authorized Official
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Title or Position | MANAGER
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Name | MISS MICHELE EDWARDS
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Credential |
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Telephone | 702-998-7400
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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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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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