Provider Demographics
NPI:1568604023
Name:ERIC V. LAC DMD LTD
Entity Type:Organization
Organization Name:ERIC V. LAC DMD LTD
Other - Org Name:SMILECITY HENDERSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:V
Authorized Official - Last Name:LAC
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-648-0011
Mailing Address - Street 1:192 CLIFF VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2707
Mailing Address - Country:US
Mailing Address - Phone:702-648-0011
Mailing Address - Fax:702-364-0011
Practice Address - Street 1:40 N VALLE VERDE DR
Practice Address - Street 2:STE 140
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-1776
Practice Address - Country:US
Practice Address - Phone:702-648-0011
Practice Address - Fax:702-364-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4563261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100513109Medicaid