Provider Demographics
NPI:1609377373
Name:H&B PEDIATRIC DENTISTRY LLC
Entity Type:Organization
Organization Name:H&B PEDIATRIC DENTISTRY LLC
Other - Org Name:MOUNTAIN'S EDGE PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BAGGALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-496-6777
Mailing Address - Street 1:5705 CENTENNIAL CENTER BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-7129
Mailing Address - Country:US
Mailing Address - Phone:702-496-6777
Mailing Address - Fax:
Practice Address - Street 1:8520 BLUE DIAMOND RD STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-9297
Practice Address - Country:US
Practice Address - Phone:702-496-6777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS6-1071223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty