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General NPI Number Information
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NPI Number | 1811748122
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Entity Type | Organization
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Legal Business Name | PRISTINE DENTAL
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Dates
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Enumeration Date | 03/27/2024
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 6925 S BUFFALO DR ST 160
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City | LAS VEGAS
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State | NV
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Zip | 89113
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Country | US
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Telephone | 702-721-9698
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Fax |
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Provider Business Mailing Address
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Address Line | 8612 WIND ROSE CT
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City | LAS VEGAS
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State | NV
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Zip | 89139-6863
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Country | US
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Telephone | 626-363-5990
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. TINA JIA LIANG
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Credential | DMD
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Telephone | 702-885-6611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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