Provider Demographics
NPI:1063675973
Name:PONCE TENDER DENTAL PD
Entity Type:Organization
Organization Name:PONCE TENDER DENTAL PD
Other - Org Name:TENDER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PONCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-436-6725
Mailing Address - Street 1:5230 BOULDER HIGHWAY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122
Mailing Address - Country:US
Mailing Address - Phone:702-436-6725
Mailing Address - Fax:702-995-0116
Practice Address - Street 1:5230 BOULDER HIGHWAY
Practice Address - Street 2:SUITE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122
Practice Address - Country:US
Practice Address - Phone:702-436-6725
Practice Address - Fax:702-995-0116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV30631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty