Provider Demographics
NPI:1275798944
Name:VIP DENTAL
Entity Type:Organization
Organization Name:VIP DENTAL
Other - Org Name:VIP DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-241-8206
Mailing Address - Street 1:3050 E DESERT INN RD
Mailing Address - Street 2:STE 105
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3870
Mailing Address - Country:US
Mailing Address - Phone:702-732-7616
Mailing Address - Fax:702-732-0418
Practice Address - Street 1:3050 E DESERT INN RD
Practice Address - Street 2:STE 105
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3870
Practice Address - Country:US
Practice Address - Phone:702-732-7616
Practice Address - Fax:702-732-0418
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID LEE DMD APC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-22
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV35181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty