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General NPI Number Information
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NPI Number | 1548592710
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Entity Type | Organization
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Legal Business Name | CORONA DENTAL & DENTURES, XA PROF. CORP.
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Dates
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Enumeration Date | 02/12/2010
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Last Update Date | 02/12/2010
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Provider Practice Location Address
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Address Line | 5080 E BONANZA RD
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City | LAS VEGAS
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State | NV
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Zip | 89110-3524
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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 | 5080 E BONANZA RD
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City | LAS VEGAS
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State | NV
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Zip | 89110-3524
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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 | DENTIST
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Name | HAI XA
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Credential | DMD
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3780
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License Number State | NV
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