| NPI | 1669524500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT WILFORD NISSON Officer In Corporation 702-454-0818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 10386) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2020-08-22 |