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NPI Code Detail

MEDICARE: DR. HIDY STAVARACHE D.D.S.

MEDICARE: DR. HIDY STAVARACHE D.D.S.
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 Dentistry3084NV

General Provider Information

NPI Number : 1457363350
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HIDY STAVARACHE D.D.S.
Provider Business Mailing Address
First Line : 9910 W CHEYENNE AVE
Second Line : #170
City : LAS VEGAS
State : NV
Zip : 89129-7707
Country : US
Telephone Number : 702-233-8371
Fax Number : 702-233-8692
Provider Business Practice Location Address
First Line : 9910 W CHEYENNE AVE
Second Line : #170
City : LAS VEGAS
State : NV
Zip : 89129-7707
Country : US
Telephone Number : 702-233-8371
Fax Number : 702-233-8692
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2006
Last Update Date : 07/23/2013

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