1336599125 NPI number — AIMEE NICOLE ABITTAN D.M.D.

Table of content: AIMEE NICOLE ABITTAN D.M.D. (NPI 1336599125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336599125 NPI number — AIMEE NICOLE ABITTAN D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABITTAN
Provider First Name:
AIMEE
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
Provider Gender Code:
F

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:
1336599125
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2250 S RANCHO DR
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89102-4451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-291-2031
Provider Business Mailing Address Fax Number:
702-984-7566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3405 MARKET ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
CARSON CITY
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89706-8021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-461-1180
Provider Business Practice Location Address Fax Number:
775-461-1181
Provider Enumeration Date:
06/13/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  6808 , 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)

  • Identifier: 1336599125 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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