Provider Demographics
NPI:1083079081
Name:NORTHERN NEVADA GENERAL DENTISTRY PRADA, PLLC
Entity Type:Organization
Organization Name:NORTHERN NEVADA GENERAL DENTISTRY PRADA, PLLC
Other - Org Name:ABSOLUTE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-787-8900
Mailing Address - Street 1:526 S TONOPAH DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4013
Mailing Address - Country:US
Mailing Address - Phone:702-435-5015
Mailing Address - Fax:
Practice Address - Street 1:6490 S. MCCARRAN BLVD. #17 & #18
Practice Address - Street 2:
Practice Address - City:LAST VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89509
Practice Address - Country:US
Practice Address - Phone:775-829-8901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABSOLUTE DENTAL & ORTHODONTICS PRADA, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS6-33C1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty