MEDICARE: NORTH VEGAS 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

General Provider Information

NPI Number	:	1922618909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH VEGAS DENTAL

Provider Business Mailing Address
First Line	:	1631 W CRAIG RD STE 10
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0227
Country	:	US
Telephone Number	:	702-649-6644
Fax Number	:

Provider Business Practice Location Address
First Line	:	1631 W CRAIG RD STE 10
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0227
Country	:	US
Telephone Number	:	702-649-6644
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	MAURICE VARGAS
Credential	:	DDS
Telephone Number	:	702-779-9320

Provider Enumeration Date	:	08/05/2020
Last Update Date	:	08/11/2020

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Directions to “NORTH VEGAS DENTAL ” Practice Location

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