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General NPI Number Information
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NPI Number | 1609236264
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Entity Type | Organization
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Legal Business Name | ACES DENTAL OF FLAGSTAFF
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Dates
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Enumeration Date | 02/24/2016
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Last Update Date | 09/16/2016
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Provider Practice Location Address
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Address Line | 1515 E CEDAR AVE UNIT C1
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-1600
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Country | US
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Telephone | 928-440-5137
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Fax | 702-243-2893
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Provider Business Mailing Address
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Address Line | 6127 S RAINBOW BLVD SUITE 100
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City | LAS VEGAS
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State | NV
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Zip | 89118-3255
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Country | US
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Telephone | 702-998-2237
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Fax | 702-243-2893
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Authorized Official
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Title or Position | OWNER
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Name | DR. VILAS SASTRY
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Credential | DMD
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Telephone | 928-440-5137
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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 | D009389
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License Number State | AZ
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