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General NPI Number Information
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NPI Number | 1780405746
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Entity Type | Individual
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Provider Name | DANIEL VIZCONDE DMD
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Gender | Male
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Dates
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Enumeration Date | 10/22/2024
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 9560 W SKYE CANYON PARK DR STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89166-6802
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Country | US
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Telephone | 702-800-5711
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Fax |
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Provider Business Mailing Address
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Address Line | 2305 BABCOCK DR
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City | LAS VEGAS
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State | NV
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Zip | 89134-0167
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Country | US
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Telephone | 562-242-9900
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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 | 8079
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License Number State | NV
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