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General NPI Number Information
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NPI Number | 1912119660
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Entity Type | Organization
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Legal Business Name | NEVADA DENTURE SERVICE
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 2605 S DECATUR BLVD SUITE 116
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City | LAS VEGAS
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State | NV
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Zip | 89102-8591
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Country | US
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Telephone | 702-878-1737
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Fax | 702-259-9634
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Provider Business Mailing Address
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Address Line | 2605 S DECATUR BLVD SUITE 116
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City | LAS VEGAS
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State | NV
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Zip | 89102-8591
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Country | US
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Telephone | 702-878-1737
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Fax | 702-259-9634
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Authorized Official
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Title or Position | OWNER
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Name | MS. LAUNA S MEANS
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Credential |
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Telephone | 702-878-1737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 550
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License Number State | NV
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