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General NPI Number Information
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NPI Number | 1619606605
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Entity Type | Organization
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Legal Business Name | SWEET SMILES LLC
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Dates
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Enumeration Date | 06/06/2022
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Last Update Date | 06/06/2022
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Provider Practice Location Address
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Address Line | 8275 S EASTERN AVE STE 101
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City | LAS VEGAS
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State | NV
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Zip | 89123-2543
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Country | US
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Telephone | 303-877-9007
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Fax |
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Provider Business Mailing Address
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Address Line | 751 LIEBER WAY
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City | HENDERSON
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State | NV
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Zip | 89052-8741
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Country | US
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Telephone | 303-877-9007
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | YI CONG
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Credential | DDS
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Telephone | 303-877-9007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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