Provider Demographics
NPI:1093983553
Name:PARADISE PARK CHILDREN'S DENTAL CLINIC
Entity Type:Organization
Organization Name:PARADISE PARK CHILDREN'S DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANANGER
Authorized Official - Prefix:
Authorized Official - First Name:WINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-432-3334
Mailing Address - Street 1:4770 HARRISON DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5563
Mailing Address - Country:US
Mailing Address - Phone:702-432-3334
Mailing Address - Fax:702-451-0583
Practice Address - Street 1:4770 HARRISON DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5563
Practice Address - Country:US
Practice Address - Phone:702-432-3334
Practice Address - Fax:702-451-0583
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S DENTAL CARE INTERNATIONAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS6231223P0221X
NVS6861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty