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NPI Code Detail

MEDICARE: MUGLESTON HENDERSON MODERN DENTISTRY, PC

MEDICARE: MUGLESTON HENDERSON MODERN DENTISTRY, 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 Dentistry4908NV

General Provider Information

NPI Number : 1558620823
Entity Type Code : Organization
Provider Name (Legal Business Name) : MUGLESTON HENDERSON MODERN DENTISTRY, PC
Provider Business Mailing Address
First Line : 17000 RED HILL AVE
Second Line :
City : IRVINE
State : CA
Zip : 92614-5626
Country : US
Telephone Number : 714-845-8890
Fax Number : 949-474-1495
Provider Business Practice Location Address
First Line : 366 W LAKE MEAD PKWY STE 100
Second Line :
City : HENDERSON
State : NV
Zip : 89015-7287
Country : US
Telephone Number : 702-464-3090
Fax Number : 702-464-3158
Authorized Official
Title or Position : DDS-OWNER
Name : DR. CODY P MUGLESTON
Credential :
Telephone Number : 702-464-3090
Provider Enumeration Date : 05/08/2012
Last Update Date : 01/15/2014

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