MEDICARE: CHILDREN'S DENTAL CENTER

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	1223P0221X	Pediatric Dentistry	S644	NV

General Provider Information

NPI Number	:	1497996219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S DENTAL CENTER

Provider Business Mailing Address
First Line	:	2085 VILLAGE CENTER CIR
Second Line	:	SUITE 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6262
Country	:	US
Telephone Number	:	702-240-5437
Fax Number	:	702-240-5436

Provider Business Practice Location Address
First Line	:	2085 VILLAGE CENTER CIR
Second Line	:	SUITE 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6262
Country	:	US
Telephone Number	:	702-240-5437
Fax Number	:	702-240-5436

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	DR. TODD S MILNE
Credential	:	D.D.S.
Telephone Number	:	702-240-5437

Provider Enumeration Date	:	03/09/2009
Last Update Date	:	03/09/2009

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Directions to “CHILDREN'S DENTAL CENTER ” Practice Location

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