Provider Demographics
NPI:1780038257
Name:FIRST PERSON CARE CLINIC
Entity Type:Organization
Organization Name:FIRST PERSON CARE CLINIC
Other - Org Name:HUNTRIDGE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-380-8118
Mailing Address - Street 1:1200 S 4TH ST STE 111
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1046
Mailing Address - Country:US
Mailing Address - Phone:702-380-8118
Mailing Address - Fax:702-380-2929
Practice Address - Street 1:1200 S 4TH ST STE 109
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1046
Practice Address - Country:US
Practice Address - Phone:702-575-0866
Practice Address - Fax:702-369-2162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
No1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1780038257Medicaid