Provider Demographics
NPI:1043812993
Name:DENTAL HYGIENE DIRECT
Entity Type:Organization
Organization Name:DENTAL HYGIENE DIRECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT CARE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RDH
Authorized Official - Phone:702-721-8405
Mailing Address - Street 1:12261 LOS MARES LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-1124
Mailing Address - Country:US
Mailing Address - Phone:714-292-3291
Mailing Address - Fax:
Practice Address - Street 1:1930 VILLAGE CENTER CIR STE 3-957
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-6299
Practice Address - Country:US
Practice Address - Phone:702-721-8405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1962649715Medicaid