MEDICARE: DR. VASHIRA TAN D.M.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	4810	NV

General Provider Information

NPI Number	:	1952377343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VASHIRA TAN D.M.D.

Provider Business Mailing Address
First Line	:	10010 W CHEYENNE AVE STE 140
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7714
Country	:	US
Telephone Number	:	702-227-4392
Fax Number	:

Provider Business Practice Location Address
First Line	:	10010 W. CHEYENNE AVE.
Second Line	:	SUITE#140
City	:	LAS VEGAS
State	:	NV
Zip	:	89129
Country	:	US
Telephone Number	:	702-227-4392
Fax Number	:

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

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	02/02/2024

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