Provider Demographics
NPI:1821745092
Name:DENTAL HISPANA LLC
Entity Type:Organization
Organization Name:DENTAL HISPANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LUISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-870-6362
Mailing Address - Street 1:4800 ALPINE PL STE 1
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-4085
Mailing Address - Country:US
Mailing Address - Phone:702-870-6362
Mailing Address - Fax:702-870-6399
Practice Address - Street 1:4800 ALPINE PL STE 1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-4085
Practice Address - Country:US
Practice Address - Phone:702-870-6362
Practice Address - Fax:702-870-6399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty