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General NPI Number Information
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NPI Number | 1578956629
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Entity Type | Organization
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Legal Business Name | TARA ERSON, DMD, PC
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Dates
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Enumeration Date | 03/13/2015
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Last Update Date | 07/29/2020
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Provider Practice Location Address
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Address Line | 6348 S RAINBOW BLVD STE 110
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City | LAS VEGAS
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State | NV
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Zip | 89118-3237
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Country | US
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Telephone | 702-518-3368
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Fax |
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Provider Business Mailing Address
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Address Line | 6348 S RAINBOW BLVD STE 110
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City | LAS VEGAS
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State | NV
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Zip | 89118-3237
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Country | US
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Telephone | 702-518-3368
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TARA ERSON
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Credential | DMD
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Telephone | 702-480-8678
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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 | 6293
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License Number State | NV
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