Provider Demographics
NPI:1497996219
Name:CHILDREN'S DENTAL CENTER
Entity Type:Organization
Organization Name:CHILDREN'S DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-240-5437
Mailing Address - Street 1:2085 VILLAGE CENTER CIR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-6262
Mailing Address - Country:US
Mailing Address - Phone:702-240-5437
Mailing Address - Fax:702-240-5436
Practice Address - Street 1:2085 VILLAGE CENTER CIR
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-6262
Practice Address - Country:US
Practice Address - Phone:702-240-5437
Practice Address - Fax:702-240-5436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS6441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty