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General NPI Number Information
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NPI Number | 1699959361
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Entity Type | Individual
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Provider Name | SUFIA PALLUCK D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 12/18/2007
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Last Update Date | 02/26/2010
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Provider Practice Location Address
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Address Line | 7720 W SAHARA AVE SUITE 107
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City | LAS VEGAS
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State | NV
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Zip | 89117-2799
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Country | US
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Telephone | 702-862-4088
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Fax |
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Provider Business Mailing Address
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Address Line | 5647 HEATHER BREEZE CT
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City | LAS VEGAS
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State | NV
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Zip | 89141-0430
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Country | US
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Telephone | 702-767-8537
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Fax | 702-693-6692
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 5123
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License Number State | NV
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