Provider Demographics
NPI:1003148040
Name:DR AMY DENTAL
Entity Type:Organization
Organization Name:DR AMY DENTAL
Other - Org Name:SILVER STATE SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TONGSIRI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-301-1195
Mailing Address - Street 1:2685 S RAINBOW BLVD
Mailing Address - Street 2:STE 107
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5182
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2685 S RAINBOW BLVD
Practice Address - Street 2:STE 107
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5182
Practice Address - Country:US
Practice Address - Phone:702-722-2324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV57331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty