MEDICARE: DR. ERVIN CALVO DDS

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	5094	NV

General Provider Information

NPI Number	:	1336204304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERVIN CALVO DDS

Provider Business Mailing Address
First Line	:	11763 LONGWORTH RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1322
Country	:	US
Telephone Number	:	310-625-1695
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 N NELLIS BLVD
Second Line	:	SUITE E8
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-5369
Country	:	US
Telephone Number	:	702-459-0303
Fax Number	:	702-459-2111

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/01/2013

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