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General NPI Number Information
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NPI Number | 1346992922
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Entity Type | Organization
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Legal Business Name | KIDS CHOICE PEDIATRIC DENTISTRY, LLC
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Dates
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Enumeration Date | 01/25/2022
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Last Update Date | 01/25/2022
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Provider Practice Location Address
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Address Line | 5680 W FLAMINGO RD STE A
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City | LAS VEGAS
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State | NV
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Zip | 89103-2339
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Country | US
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Telephone | 702-876-3222
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Fax |
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Provider Business Mailing Address
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Address Line | 5680 W FLAMINGO RD STE A
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City | LAS VEGAS
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State | NV
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Zip | 89103-2339
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Country | US
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Telephone | 702-876-3222
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Fax |
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Authorized Official
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Title or Position | CONSULTING MANAGER
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Name | STEVE IBEAWUCHI
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Credential |
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Telephone | 904-265-0765
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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 |
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License Number State |
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