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General NPI Number Information
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NPI Number | 1760863286
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Entity Type | Individual
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Provider Name | GANNON TOLMAN VANALLEN D.D.S., CERT.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2015
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 3481 E SUNSET RD STE 101
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City | LAS VEGAS
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State | NV
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Zip | 89120-6207
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Country | US
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Telephone | 702-830-4144
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Fax |
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Provider Business Mailing Address
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Address Line | 3481 E SUNSET RD STE 101
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City | LAS VEGAS
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State | NV
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Zip | 89120-6207
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Country | US
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Telephone | 702-830-4144
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | S3-372C
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License Number State | NV
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