| NPI | 1386207884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS SHANNON President 702-738-5334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-04-19 |
| Last Update Date | 2019-04-19 |