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General NPI Number Information
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NPI Number | 1265945638
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Entity Type | Organization
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Legal Business Name | TOMLIN DENTAL GROUP, PC
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Dates
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Enumeration Date | 11/08/2017
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Last Update Date | 11/08/2017
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Provider Practice Location Address
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Address Line | 6970 SOUTH CIMARRON ROAD SUITE 100
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City | LAS VEGAS
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State | NV
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Zip | 89113
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Country | US
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Telephone | 702-899-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 6970 SOUTH CIMARRON ROAD SUITE 100
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City | LAS VEGAS
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State | NV
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Zip | 89113
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. KEATON MATTHEW TOMLIN
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Credential | DMD
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Telephone | 702-423-0518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | S6-147
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | S3-305
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License Number State | NV
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