Provider Demographics
NPI:1760812622
Name:VISTA SMILE LLC
Entity Type:Organization
Organization Name:VISTA SMILE LLC
Other - Org Name:AFFORDABLE BRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE DEPARTMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:PISCHINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-522-2028
Mailing Address - Street 1:2101 S JONES BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-3133
Mailing Address - Country:US
Mailing Address - Phone:702-522-2269
Mailing Address - Fax:702-990-8856
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
Practice Address - Country:US
Practice Address - Phone:702-733-7645
Practice Address - Fax:702-823-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS3-82C1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty