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General NPI Number Information
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NPI Number | 1881815355
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Entity Type | Organization
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Legal Business Name | MOUNTAIN VIEW DENTAL
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 3625 S RAINBOW BLVD STE 103
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City | LAS VEGAS
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State | NV
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Zip | 89103-1000
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Country | US
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Telephone | 702-227-0085
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Fax | 702-227-9275
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Provider Business Mailing Address
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Address Line | 3625 S RAINBOW BLVD STE 103
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City | LAS VEGAS
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State | NV
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Zip | 89103-1000
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Country | US
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Telephone | 702-227-0085
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Fax | 702-227-9275
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL HOANG PHAN
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Credential | DDS
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Telephone | 702-227-0085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3697
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License Number State | NV
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