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General NPI Number Information
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NPI Number | 1710361894
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Entity Type | Organization
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Legal Business Name | MILESTONE DENTAL
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 07/17/2015
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Provider Practice Location Address
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Address Line | 4270 S DECATUR BLVD SUITE A2
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City | LAS VEGAS
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State | NV
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Zip | 89103-6800
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Country | US
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Telephone | 702-795-7771
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Fax | 702-722-6940
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Provider Business Mailing Address
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Address Line | 4270 S DECATUR BLVD SUITE A2
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City | LAS VEGAS
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State | NV
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Zip | 89103-6800
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Country | US
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Telephone | 702-795-7771
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Fax | 702-722-6940
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. LUIZ ALFREDO DOS SANTOS
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Credential | DMD
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Telephone | 702-795-7771
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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 | 5058
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License Number State | NV
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