1427151240 NPI number — BOARD OF REGENTS, NEVADA SYSTEM OF HIGHER EDUCATION

Table of content: (NPI 1427151240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427151240 NPI number — BOARD OF REGENTS, NEVADA SYSTEM OF HIGHER EDUCATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOARD OF REGENTS, NEVADA SYSTEM OF HIGHER EDUCATION
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:
UNLV FACULTY DENTAL PRACTICE
Provider Other Organization Name Type Code:
5
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:
1427151240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 SHADOW LANE
Provider Second Line Business Mailing Address:
MS 7413
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89106-4124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-774-2400
Provider Business Mailing Address Fax Number:
702-774-2499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 W. CHARLESTON BLVD.
Provider Second Line Business Practice Location Address:
BUILDING D
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89102-2351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-774-8000
Provider Business Practice Location Address Fax Number:
702-774-2499
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EVANS
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
DIRECTOR OF CLINICAL BUSINESS SVCS.
Authorized Official Telephone Number:
702-774-2819

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  4293 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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