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NPI Code Detail

MEDICARE: MS. SUSAN E LEGRAND RDH

MEDICARE: MS. SUSAN E LEGRAND RDH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1124Q00000XDental Hygienist3646NV

General Provider Information

NPI Number : 1013216340
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN E LEGRAND RDH
Provider Business Mailing Address
First Line : 3074 ARVILLE ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-7490
Country : US
Telephone Number : 702-889-3763
Fax Number :
Provider Business Practice Location Address
First Line : 3074 ARVILLE ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-7490
Country : US
Telephone Number : 702-889-3763
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2011
Last Update Date : 03/01/2012

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1588963615 — FUTURE SMILES
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Directions to “ MS. SUSAN E LEGRAND RDH” Practice Location

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