Provider Demographics
NPI:1437479565
Name:HASKINS-MOHR, EILEEN FRANCES (RDH)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:FRANCES
Last Name:HASKINS-MOHR
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3074 ARVILLE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-7490
Mailing Address - Country:US
Mailing Address - Phone:702-889-3763
Mailing Address - Fax:702-889-3591
Practice Address - Street 1:4145 JIMMY DURANTE BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-5431
Practice Address - Country:US
Practice Address - Phone:702-521-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10099124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV10099OtherNEVADA STATE DENTAL HYGIENE LICENSE