Provider Demographics
NPI:1629164769
Name:NEVADA ORTHODONTIC CARE, LLC
Entity Type:Organization
Organization Name:NEVADA ORTHODONTIC CARE, LLC
Other - Org Name:NEVADA ORTHODONTIC CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-541-9504
Mailing Address - Street 1:2600 S RAINBOW BLVD
Mailing Address - Street 2:101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-4006
Mailing Address - Country:US
Mailing Address - Phone:702-733-7645
Mailing Address - Fax:
Practice Address - Street 1:2600 S RAINBOW BLVD
Practice Address - Street 2:101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-4006
Practice Address - Country:US
Practice Address - Phone:702-733-7645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV43321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty