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NPI Code Detail

MEDICARE: ERIC AVITIA DDS, LLC

MEDICARE: ERIC AVITIA DDS, LLC
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
11223G0001XGeneral Practice Dentistry5609NV

General Provider Information

NPI Number : 1194128298
Entity Type Code : Organization
Provider Name (Legal Business Name) : ERIC AVITIA DDS, LLC
Provider Business Mailing Address
First Line : 7945 W SAHARA AVE STE 101
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-7908
Country : US
Telephone Number : 702-363-0421
Fax Number : 702-363-8951
Provider Business Practice Location Address
First Line : 7945 W SAHARA AVE STE 101
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-7908
Country : US
Telephone Number : 702-363-0421
Fax Number : 702-363-8951
Authorized Official
Title or Position : OWNER/DENTIST
Name : DR. ERIC ALLAN AVITIA
Credential : DDS
Telephone Number : 702-513-9326
Provider Enumeration Date : 10/02/2014
Last Update Date : 10/02/2014

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