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General NPI Number Information
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NPI Number | 1962978601
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Entity Type | Organization
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Legal Business Name | ELEGANT SMILES, LLC
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Dates
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Enumeration Date | 10/21/2018
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 6910 S CIMARRON RD STE 200
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City | LAS VEGAS
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State | NV
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Zip | 89113-2135
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Country | US
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Telephone | 702-805-4555
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Fax | 702-500-0416
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Provider Business Mailing Address
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Address Line | 6910 S CIMARRON RD STE 200
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City | LAS VEGAS
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State | NV
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Zip | 89113-2280
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Country | US
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Telephone | 702-805-4555
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Fax | 702-500-0416
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. PHI PHAN
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Credential | DDS
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Telephone | 702-805-4555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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