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Dental Providers Dentist Orthodontics and Dentofacial Orthopedics

Provider NPI: 1619121159

Organization Information:
Organization is not Subpart
Authorized Official:  JAMES K MAH  PARTNER  702-750-2400

Practice Location:
6002 S DURANGO DR SUITE 100 LAS VEGAS, NV 89113-1785 US
Tel: 702-750-2400  Fax: 702-750-2401

Business Mailing Address:
PO BOX 400760  LAS VEGAS, NV 89140-0760 US
Tel: 702-750-2400  Fax: 702-750-2401

NPI Information:
NPI: 1619121159
Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
N1223X0400XDental Providers
Orthodontics and Dentofacial Orthopedics
Y1223X0400XDental Providers

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 1223X0400X





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