| Star Smiles Childrens Dentistry | |
|
4040 North Martin Luther King Bl Suite B North Las Vegas NV 89032-3206 | |
| (702) 639-3515 | |
| (702) 639-3516 |
| Full Name | Star Smiles Childrens Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 4040 North Martin Luther King Bl, North Las Vegas, Nevada |
| Authorized Official Name and Position | Timothy A Wilson (DENTIST) |
| Authorized Official Contact | 7026393515 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Star Smiles Childrens Dentistry 4040 North Martin Luther King Blvd. Suite B North Las Vegas NV 89032-6330 Ph: (702) 639-3515 | Star Smiles Childrens Dentistry 4040 North Martin Luther King Bl Suite B North Las Vegas NV 89032-3206 Ph: (702) 639-3515 |
| NPI Number | 1518097153 |
|---|---|
| Provider Enumeration Date | 03/06/2007 |
| Last Update Date | 04/04/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518097153 | NPI | - | NPPES |
| 100506669 | Medicaid | NV | |
| 100502976 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 4522T (Nevada) | Primary |
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