Provider Demographics
NPI:1619121159
Name:DURANGO ORTHODONTICS, LLLP
Entity Type:Organization
Organization Name:DURANGO ORTHODONTICS, LLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSC, MRCD(C), D
Authorized Official - Phone:702-750-2400
Mailing Address - Street 1:PO BOX 400760
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89140-0760
Mailing Address - Country:US
Mailing Address - Phone:702-750-2400
Mailing Address - Fax:702-750-2401
Practice Address - Street 1:6002 S DURANGO DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1785
Practice Address - Country:US
Practice Address - Phone:702-750-2400
Practice Address - Fax:702-750-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS3-1381223X0400X
NVS3-1661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty