MEDICARE: MS. NANTIYA HARNUKAL JOE D.D.S., M.S

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	3225	NV

General Provider Information

NPI Number	:	1942314182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANTIYA HARNUKAL JOE D.D.S., M.S

Provider Business Mailing Address
First Line	:	2941 AQUALINE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2576
Country	:	US
Telephone Number	:	702-242-4249
Fax Number	:

Provider Business Practice Location Address
First Line	:	9155 W FLAMINGO RD
Second Line	:	120
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-6894
Country	:	US
Telephone Number	:	702-838-8112
Fax Number	:	702-838-1907

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/08/2007

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