1346314804 NPI number — QUALITY DENTAL SMILE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346314804 NPI number — QUALITY DENTAL SMILE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY DENTAL SMILE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346314804
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2670 S JONES BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-880-9527
Provider Business Mailing Address Fax Number:
702-880-9532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2670 S JONES
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-880-9527
Provider Business Practice Location Address Fax Number:
702-880-9532
Provider Enumeration Date:
11/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DOMINGO
Authorized Official First Name:
JOHN RHONNEL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
702-880-9527

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  4076 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)