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General NPI Number Information
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NPI Number | 1306471826
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Entity Type | Organization
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Legal Business Name | RAINBOW DENTAL PARTNERS LLC
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Dates
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Enumeration Date | 03/04/2020
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Last Update Date | 03/04/2020
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Provider Practice Location Address
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Address Line | 3163 N RAINBOW BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89108-4578
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Country | US
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Telephone | 702-805-1178
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Fax | 702-763-8885
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Provider Business Mailing Address
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Address Line | 4750 W SAHARA AVE STE 12
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City | LAS VEGAS
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State | NV
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Zip | 89102-3559
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Country | US
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Telephone | 702-456-0005
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Fax | 702-763-8885
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Authorized Official
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Title or Position | GENERAL MANAGER OF OPORATIONS
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Name | DIANA JESSENIA CAZZALY
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Credential |
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Telephone | 702-456-0005
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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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