Provider Demographics
NPI:1639336597
Name:A CHILDRENS DENTIST LLP
Entity Type:Organization
Organization Name:A CHILDRENS DENTIST LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MNG. PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SAXE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-255-0133
Mailing Address - Street 1:8710 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5469
Mailing Address - Country:US
Mailing Address - Phone:702-255-0133
Mailing Address - Fax:702-255-8374
Practice Address - Street 1:8710 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5469
Practice Address - Country:US
Practice Address - Phone:702-255-0133
Practice Address - Fax:702-255-8374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS6-161223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002202099Medicaid