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NPI Code Detail

MEDICARE: BEAUTI' DEN CROWN RESTORATION CLINIC

MEDICARE: BEAUTI' DEN CROWN RESTORATION CLINIC
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
1174400000XSpecialist
2332BC3200XCustomized Equipment (DME)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11609300011OTHERNVINSURANCE
21104456557OTHERNVCRANIAL PROTHESIS

General Provider Information

NPI Number : 1104456557
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEAUTI' DEN CROWN RESTORATION CLINIC
Provider Business Mailing Address
First Line : 9850 S MARYLAND PKWY # 503
Second Line :
City : LAS VEGAS
State : NV
Zip : 89183-7146
Country : US
Telephone Number : 702-351-0502
Fax Number :
Provider Business Practice Location Address
First Line : 9850 S MARYLAND PKWY # 503
Second Line :
City : LAS VEGAS
State : NV
Zip : 89183-7146
Country : US
Telephone Number : 702-351-0502
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : PATTI PENNINGTON
Credential :
Telephone Number : 702-351-0502
Provider Enumeration Date : 01/23/2020
Last Update Date : 04/29/2026

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Directions to “BEAUTI' DEN CROWN RESTORATION CLINIC ” Practice Location

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