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General NPI Number Information
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NPI Number | 1417085010
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Entity Type | Organization
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Legal Business Name | STAR BRITE DENTAL, XA PROF. CORP.
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 893 S RAINBOW BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89145-6238
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Country | US
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Telephone | 702-456-0034
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Fax | 702-856-0035
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Provider Business Mailing Address
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Address Line | 893 S RAINBOW BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89145-6238
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Country | US
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Telephone | 702-456-0034
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Fax | 702-856-0035
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HAI Q. XA
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Credential | D.M.D.
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Telephone | 702-456-0034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 3780
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License Number State | NV
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