Provider Demographics
NPI:1144596800
Name:COMPLETE DENTAL LLC
Entity Type:Organization
Organization Name:COMPLETE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JONG
Authorized Official - Middle Name:SOOK
Authorized Official - Last Name:JIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-227-5800
Mailing Address - Street 1:2625 S RAINBOW BLVD
Mailing Address - Street 2:#D100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5198
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2625 S RAINBOW BLVD
Practice Address - Street 2:#D100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5198
Practice Address - Country:US
Practice Address - Phone:702-227-5800
Practice Address - Fax:702-227-5801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV47591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty