Provider Demographics
NPI:1447576665
Name:DENTAL NATION
Entity Type:Organization
Organization Name:DENTAL NATION
Other - Org Name:KLINE C. BLACK, DMD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KLINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-642-8101
Mailing Address - Street 1:1500 E DESERT INN RD
Mailing Address - Street 2:STE #3
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-2550
Mailing Address - Country:US
Mailing Address - Phone:702-642-8101
Mailing Address - Fax:702-642-1131
Practice Address - Street 1:1500 E DESERT INN RD
Practice Address - Street 2:STE #3
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2550
Practice Address - Country:US
Practice Address - Phone:702-642-8101
Practice Address - Fax:702-642-1131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service