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General NPI Number Information
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NPI Number | 1275998270
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Entity Type | Organization
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Legal Business Name | SOUTHERN NEVADA SPECIALTY PRADA, PLLC
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Dates
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Enumeration Date | 12/18/2015
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 8380 W CHEYENNE AVE #104
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City | LAS VEGAS
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State | NV
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Zip | 89129-8405
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Country | US
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Telephone | 702-733-0888
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Fax | 702-395-8718
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Provider Business Mailing Address
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Address Line | 2250 S RANCHO DR SUITE 205
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City | LAS VEGAS
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State | NV
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Zip | 89102-4451
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Country | US
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Telephone | 702-291-2031
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Fax | 702-984-7566
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Authorized Official
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Title or Position | OWNER
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Name | PATRICIA PRADA
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Credential | DDS
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Telephone | 702-291-2031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | S6-33C
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | S6-33C
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | S6-33C
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | S6-33C
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License Number State | NV
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