MEDICARE: ALYSSA MIYUKI ARIYOSHI DMD

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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	7374	NV

General Provider Information

NPI Number	:	1093335598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA MIYUKI ARIYOSHI DMD

Provider Business Mailing Address
First Line	:	3904 SWEET PINE ST UNIT 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-8181
Country	:	US
Telephone Number	:	808-344-7583
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 S LAMB BLVD STE 400
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-5540
Country	:	US
Telephone Number	:	702-780-7660
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2020
Last Update Date	:	07/13/2021

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