| NPI | 1528430790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA PRADA Member 702-733-0888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV S6-33C) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NV S6-33C) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV S6-33C) | |
| Enumeration Date | 2015-10-27 |
| Last Update Date | 2015-10-27 |