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General NPI Number Information
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NPI Number | 1801087390
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Entity Type | Organization
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Legal Business Name | AQUA KIDS DENTAL, INC
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 08/08/2007
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Provider Practice Location Address
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Address Line | 3945 S MARYLAND PKWY SUITE A
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City | LAS VEGAS
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State | NV
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Zip | 89119-7562
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Country | US
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Telephone | 702-369-8686
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Fax | 702-369-9503
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Provider Business Mailing Address
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Address Line | 3945 S MARYLAND PKWY SUITE A
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City | LAS VEGAS
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State | NV
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Zip | 89119-7562
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Country | US
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Telephone | 702-369-8686
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Fax | 702-369-9503
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Authorized Official
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Title or Position | OWNER
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Name | DR. GURBRINDER DHILLON
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Credential |
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Telephone | 702-369-8686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | S6-81
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License Number State | NV
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