Provider Demographics
NPI:1043400534
Name:MACK, JOHN F (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:MACK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 E DESERT INN RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-2548
Mailing Address - Country:US
Mailing Address - Phone:702-655-6777
Mailing Address - Fax:702-547-3522
Practice Address - Street 1:1580 E DESERT INN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2548
Practice Address - Country:US
Practice Address - Phone:702-655-6777
Practice Address - Fax:702-547-3522
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4652122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist