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General NPI Number Information
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NPI Number | 1710545272
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Entity Type | Individual
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Provider Name | CRYSTAL VISS DMD
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Gender | Female
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Dates
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Enumeration Date | 05/30/2019
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Last Update Date | 10/08/2022
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Provider Practice Location Address
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Address Line | 2380 VIA INSPIRADA STE 100B
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City | HENDERSON
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State | NV
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Zip | 89044-1853
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Country | US
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Telephone | 702-703-8359
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Fax |
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Provider Business Mailing Address
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Address Line | 2380 VIA INSPIRADA STE 100B
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City | HENDERSON
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State | NV
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Zip | 89044-1853
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Country | US
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Telephone |
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | PENDING
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | S6-215
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License Number State | NV
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