Provider Demographics
NPI:1629573266
Name:NEA DENTISTRY LLC
Entity Type:Organization
Organization Name:NEA DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:BONIFATTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-256-6001
Mailing Address - Street 1:2085 VILLAGE CENTER CIR STE 140
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-6263
Mailing Address - Country:US
Mailing Address - Phone:702-256-6001
Mailing Address - Fax:
Practice Address - Street 1:2085 VILLAGE CENTER CIR STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-6263
Practice Address - Country:US
Practice Address - Phone:860-491-6972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty