MEDICARE: MARVELYN NAVARRO 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
1	124Q00000X	Dental Hygienist	102195	NV

General Provider Information

NPI Number	:	1194586248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARVELYN NAVARRO RDH

Provider Business Mailing Address
First Line	:	256 CHARTAN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-5140
Country	:	US
Telephone Number	:	702-785-4367
Fax Number	:

Provider Business Practice Location Address
First Line	:	1930 VILLAGE CENTER CIR STE 3957
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6299
Country	:	US
Telephone Number	:	714-292-3291
Fax Number	:

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

Provider Enumeration Date	:	01/17/2024
Last Update Date	:	01/25/2024

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