MEDICARE: ROYAL DENTAL

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1255848693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL DENTAL

Provider Business Mailing Address
First Line	:	4506 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1502
Country	:	US
Telephone Number	:	702-266-3390
Fax Number	:

Provider Business Practice Location Address
First Line	:	4506 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102
Country	:	US
Telephone Number	:	702-266-3390
Fax Number	:	702-266-3390

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	ABRIL PEREZ
Credential	:
Telephone Number	:	702-266-3390

Provider Enumeration Date	:	01/08/2018
Last Update Date	:	01/08/2018

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Directions to “ROYAL DENTAL ” Practice Location

Language	Start Address	Practice Location

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