Provider Demographics
NPI:1013013283
Name:POINTE NORTH DENTAL
Entity Type:Organization
Organization Name:POINTE NORTH DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-396-9924
Mailing Address - Street 1:7312 W CHEYENNE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7428
Mailing Address - Country:US
Mailing Address - Phone:702-396-9924
Mailing Address - Fax:702-396-3735
Practice Address - Street 1:7312 W CHEYENNE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7428
Practice Address - Country:US
Practice Address - Phone:702-396-9924
Practice Address - Fax:702-396-3735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3336251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare