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NPI Code Detail

MEDICARE: FADDIS DENTISTS OF NORTH LAS VEGAS, PC

MEDICARE: FADDIS DENTISTS OF NORTH LAS VEGAS, PC
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 Dentistry

General Provider Information

NPI Number : 1255866158
Entity Type Code : Organization
Provider Name (Legal Business Name) : FADDIS DENTISTS OF NORTH LAS VEGAS, PC
Provider Business Mailing Address
First Line : PO BOX 920050
Second Line :
City : DALLAS
State : TX
Zip : 75392-0050
Country : US
Telephone Number : 714-845-8500
Fax Number :
Provider Business Practice Location Address
First Line : 6180 N DECATUR BLVD
Second Line : SUITE 100
City : LAS VEGAS
State : NV
Zip : 89130-1505
Country : US
Telephone Number : 702-359-3107
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. SPENCER FADDIS
Credential : DDS
Telephone Number : 702-359-3107
Provider Enumeration Date : 04/28/2017
Last Update Date : 04/13/2022

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Directions to “FADDIS DENTISTS OF NORTH LAS VEGAS, PC ” Practice Location

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