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7181 N Hualapai Way Suite 105 Las Vegas NV 89166-1115 | |
| (702) 349-2420 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 7181 N Hualapai Way, Las Vegas, Nevada |
| Authorized Official Name and Position | Tiffany Lorick (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 7048063632 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 35145 Lb 413169 Seattle WA 98124 Ph: (919) 948-6787 | 7181 N Hualapai Way Suite 105 Las Vegas NV 89166-1115 Ph: (702) 349-2420 |
| NPI Number | 1417313883 |
|---|---|
| Provider Enumeration Date | 01/14/2016 |
| Last Update Date | 01/03/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417313883 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | S6-81 (Nevada) | Primary |
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