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General NPI Number Information
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NPI Number | 1508995598
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Entity Type | Organization
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Legal Business Name | STAR BRITE DENTAL, HAI Q. XA D.M.D. PROF. CORP.
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 560 MARKS ST STE B
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City | HENDERSON
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State | NV
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Zip | 89014-8602
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Country | US
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Telephone | 702-456-5100
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Fax | 702-456-5102
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Provider Business Mailing Address
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Address Line | 560 MARKS ST STE B
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City | HENDERSON
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State | NV
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Zip | 89014-8602
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Country | US
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Telephone | 702-456-5100
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Fax | 702-456-5102
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Authorized Official
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Title or Position | PRESIDENT
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Name | HAI Q. XA
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Credential | D.M.D.
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Telephone | 702-456-5100
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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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