=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548582166
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AFFINITY DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2010
-----------------------------------------------------
Last Update Date | 02/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1811 S RAINBOW BLVD SUITE 101
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89146-0894
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-562-5044
-----------------------------------------------------
Fax | 702-562-3289
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1811 S RAINBOW BLVD SUITE 101
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89146-0894
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-562-5044
-----------------------------------------------------
Fax | 702-562-3289
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. JAMES B CURTIS
-----------------------------------------------------
Credential | D D S
-----------------------------------------------------
Telephone | 702-562-3289
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | NV2367
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------