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General NPI Number Information
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NPI Number | 1346509668
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Entity Type | Organization
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Legal Business Name | EXCEL DENTAL CARE
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Dates
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Enumeration Date | 05/07/2012
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Last Update Date | 09/14/2015
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Provider Practice Location Address
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Address Line | 6002 S DURANGO DR
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City | LAS VEGAS
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State | NV
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Zip | 89113-1785
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Country | US
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Telephone | 775-453-0287
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Fax |
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Provider Business Mailing Address
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Address Line | 6002 S DURANGO DR
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City | LAS VEGAS
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State | NV
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Zip | 89113-1785
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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 | PRESIDENT
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Name | DR. YEONG W KIM
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Credential |
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Telephone | 775-453-0287
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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 | 4280
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License Number State | NV
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