Provider Demographics
NPI:1508191420
Name:PURE DENTAL
Entity Type:Organization
Organization Name:PURE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRANG
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-456-4600
Mailing Address - Street 1:4250 S RAINBOW BLVD
Mailing Address - Street 2:#1004-1005
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-3159
Mailing Address - Country:US
Mailing Address - Phone:702-456-4600
Mailing Address - Fax:702-456-3600
Practice Address - Street 1:4250 S RAINBOW BLVD
Practice Address - Street 2:#1004-1005
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3159
Practice Address - Country:US
Practice Address - Phone:702-456-4600
Practice Address - Fax:702-456-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV47091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty