Provider Demographics
NPI:1487828356
Name:LAS VEGAS ORAL SURGERY INC
Entity Type:Organization
Organization Name:LAS VEGAS ORAL SURGERY INC
Other - Org Name:LAS VEGAS ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-204-8862
Mailing Address - Street 1:7670 W LAKE MEAD BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-6649
Mailing Address - Country:US
Mailing Address - Phone:702-312-2273
Mailing Address - Fax:702-312-2276
Practice Address - Street 1:7670 W LAKE MEAD BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-6649
Practice Address - Country:US
Practice Address - Phone:702-312-2273
Practice Address - Fax:702-312-2276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS2-261223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty