Provider Demographics
NPI:1619585353
Name:GREEN VALLEY DENTISTRY
Entity Type:Organization
Organization Name:GREEN VALLEY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:DAN
Authorized Official - Last Name:SOARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-456-7818
Mailing Address - Street 1:11 S STEPHANIE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-6034
Mailing Address - Country:US
Mailing Address - Phone:702-456-7818
Mailing Address - Fax:702-456-7264
Practice Address - Street 1:11 S STEPHANIE ST STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-6034
Practice Address - Country:US
Practice Address - Phone:702-456-7818
Practice Address - Fax:702-456-1264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental