Provider Demographics
NPI:1548575996
Name:RADIANT SMILES SERIES 3 LLC
Entity Type:Organization
Organization Name:RADIANT SMILES SERIES 3 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:FABIAN
Authorized Official - Last Name:CORDERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-480-6011
Mailing Address - Street 1:2633 W HORIZON RIDGE PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4833
Mailing Address - Country:US
Mailing Address - Phone:702-897-7001
Mailing Address - Fax:702-897-7201
Practice Address - Street 1:2633 W HORIZON RIDGE PKWY STE 130
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4833
Practice Address - Country:US
Practice Address - Phone:702-897-7001
Practice Address - Fax:702-897-7201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV47251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty