MEDICARE: CARIS CROW D.D.S., M.A.G.D.

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	1093	NV

General Provider Information

NPI Number	:	1912962598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARIS CROW D.D.S., M.A.G.D.

Provider Business Mailing Address
First Line	:	2880 E FLAMINGO RD
Second Line	:	SUITE H
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5223
Country	:	US
Telephone Number	:	702-737-6080
Fax Number	:	702-699-9085

Provider Business Practice Location Address
First Line	:	2880 E FLAMINGO RD
Second Line	:	SUITE H
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5223
Country	:	US
Telephone Number	:	702-737-6080
Fax Number	:	702-699-9085

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	07/08/2007

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