MEDICARE: DR. ERIC A. AVITIA 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	5609	NV

General Provider Information

NPI Number	:	1609051903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC A. AVITIA DDS

Provider Business Mailing Address
First Line	:	7945 W SAHARA AVE STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7908
Country	:	US
Telephone Number	:	702-363-0421
Fax Number	:	702-363-8951

Provider Business Practice Location Address
First Line	:	7945 W SAHARA AVE
Second Line	:	STE 101
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7950
Country	:	US
Telephone Number	:	702-363-0421
Fax Number	:	702-363-8951

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

Provider Enumeration Date	:	01/04/2008
Last Update Date	:	04/15/2015

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