Provider Demographics
NPI:1548592710
Name:CORONA DENTAL & DENTURES, XA PROF. CORP.
Entity Type:Organization
Organization Name:CORONA DENTAL & DENTURES, XA PROF. CORP.
Other - Org Name:CORONA DENTAL & DENTURES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HAI
Authorized Official - Middle Name:
Authorized Official - Last Name:XA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-456-5100
Mailing Address - Street 1:5080 E BONANZA RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-3524
Mailing Address - Country:US
Mailing Address - Phone:702-456-5100
Mailing Address - Fax:702-456-5102
Practice Address - Street 1:5080 E BONANZA RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-3524
Practice Address - Country:US
Practice Address - Phone:702-456-5100
Practice Address - Fax:702-456-5102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV37801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty