1992269179 NPI number — CUTLER DENTAL CARE, PLLC

Table of content: (NPI 1992269179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992269179 NPI number — CUTLER DENTAL CARE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUTLER DENTAL CARE, PLLC
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:
6
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:
1992269179
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SHADOW MOUNTAIN DENTAL GROUP
Provider Second Line Business Mailing Address:
6525 N. DECATUR BLVD. STE. 150
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-577-1941
Provider Business Mailing Address Fax Number:
702-395-7813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9690 W TROPICANA AVE
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:
89147-2601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-277-6575
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2019

Additional Information

Authorized Official

Authorized Official Last Name:
CUTLER
Authorized Official First Name:
JEROME
Authorized Official Middle Name:
C
Authorized Official Title or Position:
DENTIST/OWNER
Authorized Official Telephone Number:
928-830-0175

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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