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General NPI Number Information
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NPI Number | 1881136646
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Entity Type | Organization
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Legal Business Name | ALLURA ORTHODONTICS
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Dates
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Enumeration Date | 11/10/2016
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Last Update Date | 11/10/2016
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Provider Practice Location Address
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Address Line | 3039 W HORIZON RIDGE PKWY SUITE 100
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City | HENDERSON
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State | NV
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Zip | 89052-4192
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Country | US
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Telephone | 702-489-5237
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Fax |
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Provider Business Mailing Address
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Address Line | 3039 W HORIZON RIDGE PKWY SUITE 100
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City | HENDERSON
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State | NV
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Zip | 89052-4192
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Country | US
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Telephone | 702-489-5237
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. PAWAN GAUTAM
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Credential | DMD, MDS
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Telephone | 702-489-5237
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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 | S3-245C
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License Number State | NV
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