| NPI | 1528305265 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA LEE DESPIGANOVICZ Administrator 702-492-9399 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 4178) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2013-01-15 |