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General NPI Number Information
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NPI Number | 1558547869
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Entity Type | Organization
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Legal Business Name | S ROBERT LEAVER
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | 4610 MEADOWS LN
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City | LAS VEGAS
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State | NV
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Zip | 89107-2965
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Country | US
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Telephone | 702-274-4566
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Fax | 702-878-1397
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Provider Business Mailing Address
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Address Line | 4610 MEADOWS LN
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City | LAS VEGAS
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State | NV
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Zip | 89107-2965
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Country | US
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Telephone | 702-274-4566
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Fax | 702-878-1397
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Authorized Official
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Title or Position | PRESIDENT
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Name | S ROBERT LEAVER III
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Credential |
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Telephone | 702-274-4566
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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 | S3-17
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License Number State | NV
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