Provider Demographics
NPI:1376709196
Name:US DENTAL WASHINGTON INC
Entity Type:Organization
Organization Name:US DENTAL WASHINGTON INC
Other - Org Name:US DENTAL WASHINGTON INC
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 1:4440 E WASHINGTON AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-5792
Mailing Address - Country:US
Mailing Address - Phone:702-437-1000
Mailing Address - Fax:702-437-0653
Practice Address - Street 1:4440 E WASHINGTON AVE
Practice Address - Street 2:STE 102
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5792
Practice Address - Country:US
Practice Address - Phone:702-437-1000
Practice Address - Fax:702-437-0653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV35181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty