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4080 N Martin L King Blvd Suite 101 B N Las Vegas NV 89032-3216 | |
| (425) 306-2579 | |
| (888) 583-4140 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4080 N Martin L King Blvd, N Las Vegas, Nevada |
| Authorized Official Name and Position | Steven Delisle (OWNER) |
| Authorized Official Contact | 4253062579 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2480 E Tompkins Ave Suite 102 Las Vegas NV 89121-7394 Ph: (425) 306-2579 | 4080 N Martin L King Blvd Suite 101 B N Las Vegas NV 89032-3216 Ph: (425) 306-2579 |
| NPI Number | 1568798874 |
|---|---|
| Provider Enumeration Date | 10/20/2009 |
| Last Update Date | 09/19/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568798874 | NPI | - | NPPES |
| 22 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5929 (Nevada) | Primary |
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