MEDICARE: MILESTONE DENTAL

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	122300000X	Dentist	5058	NV

General Provider Information

NPI Number	:	1710361894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILESTONE DENTAL

Provider Business Mailing Address
First Line	:	4270 S DECATUR BLVD
Second Line	:	SUITE A2
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-6800
Country	:	US
Telephone Number	:	702-795-7771
Fax Number	:	702-722-6940

Provider Business Practice Location Address
First Line	:	4270 S DECATUR BLVD
Second Line	:	SUITE A2
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-6800
Country	:	US
Telephone Number	:	702-795-7771
Fax Number	:	702-722-6940

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. LUIZ ALFREDO DOS SANTOS
Credential	:	DMD
Telephone Number	:	702-795-7771

Provider Enumeration Date	:	07/17/2015
Last Update Date	:	07/17/2015

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Directions to “MILESTONE DENTAL ” Practice Location

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