Provider Demographics
NPI:1043582810
Name:ERNESTO BARBOSA DMD, P.C.
Entity Type:Organization
Organization Name:ERNESTO BARBOSA DMD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-278-0876
Mailing Address - Street 1:1264 S NELLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-5782
Mailing Address - Country:US
Mailing Address - Phone:702-243-2489
Mailing Address - Fax:702-438-4428
Practice Address - Street 1:1264 S NELLIS BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-5782
Practice Address - Country:US
Practice Address - Phone:702-243-2489
Practice Address - Fax:702-438-4428
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ERNESTO BARBOSA DMD, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6060122300000X
NV83611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty