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General NPI Number Information
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NPI Number | 1356701296
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Entity Type | Organization
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Legal Business Name | PERFECT 32 DENTAL CARE LLC
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Dates
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Enumeration Date | 03/04/2016
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Last Update Date | 03/04/2016
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Provider Practice Location Address
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Address Line | 2810 W CHARLESTON BLVD STE F56
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City | LAS VEGAS
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State | NV
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Zip | 89102-1921
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Country | US
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Telephone | 702-486-5107
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Fax | 702-486-6254
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Provider Business Mailing Address
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Address Line | 2810 W CHARLESTON BLVD STE F56
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City | LAS VEGAS
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State | NV
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Zip | 89102-1921
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Country | US
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Telephone | 702-486-5107
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Fax | 702-486-6254
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Authorized Official
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Title or Position | OWNER
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Name | MAEN HIJAZI
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Credential |
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Telephone | 702-486-5107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6551
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License Number State | NV
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