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General NPI Number Information
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NPI Number | 1851798581
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Entity Type | Organization
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Legal Business Name | VALLEY PEDIATRIC DENTAL
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 350 FALCON RIDGE PKWY BUILDING #200 STE#101
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City | MESQUITE
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State | NV
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Zip | 89027-8878
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Country | US
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Telephone | 888-963-9601
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Fax | 888-963-9601
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Provider Business Mailing Address
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Address Line | 350 FALCON RIDGE PKWY BUILDING #200 STE#101
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City | MESQUITE
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State | NV
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Zip | 89027-8878
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Country | US
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Telephone | 888-963-9601
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Fax | 888-963-9601
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. HALEY A MACIAS
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Credential |
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Telephone | 888-963-9601
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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 | S697
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License Number State | NV
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