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General NPI Number Information
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NPI Number | 1922657808
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Entity Type | Organization
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Legal Business Name | AXIOM DENTISTRY, LLC
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Dates
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Enumeration Date | 09/04/2019
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Last Update Date | 09/04/2019
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Provider Practice Location Address
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Address Line | 410 S RAMPART BLVD STE 360
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City | LAS VEGAS
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State | NV
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Zip | 89145-5730
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Country | US
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Telephone | 702-228-2218
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Fax | 702-228-7411
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Provider Business Mailing Address
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Address Line | 4358 W CHEYENNE AVE
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-2484
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Country | US
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Telephone | 714-578-6591
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR
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Name | BEATRIZ HERNANDEZ
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Credential |
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Telephone | 714-578-6591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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