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NPI Code Detail

MEDICARE: MR. JORGE PAEZ D.D.S

MEDICARE: MR. JORGE PAEZ D.D.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
1122300000XDentist2943NV

General Provider Information

NPI Number : 1952707440
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JORGE PAEZ D.D.S
Provider Business Mailing Address
First Line : 4455 S JONES BLVD
Second Line : SUITE E2
City : LAS VEGAS
State : NV
Zip : 89103-3372
Country : US
Telephone Number : 702-737-3553
Fax Number : 702-873-5100
Provider Business Practice Location Address
First Line : 4455 S JONES BLVD
Second Line : SUITE E2
City : LAS VEGAS
State : NV
Zip : 89103-3372
Country : US
Telephone Number : 702-737-3553
Fax Number : 702-873-5100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2014
Last Update Date : 11/10/2014

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