MEDICARE: VILAS BALAKRISHNA DMD 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
1	122300000X	Dentist	5053	NV

General Provider Information

NPI Number	:	1780916411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILAS BALAKRISHNA DMD PC

Provider Business Mailing Address
First Line	:	6127 S RAINBOW BLVD
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3255
Country	:	US
Telephone Number	:	702-998-2237
Fax Number	:	702-243-2893

Provider Business Practice Location Address
First Line	:	6127 SOUTH RAINBOW
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3256
Country	:	US
Telephone Number	:	702-998-2237
Fax Number	:	702-243-2893

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VILAS BALAKRISHNA
Credential	:	DMD
Telephone Number	:	702-998-2237

Provider Enumeration Date	:	02/05/2010
Last Update Date	:	01/27/2012

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