Provider Demographics
NPI:1851019913
Name:CENTER FOR DENTAL AESTHETICS PLLC
Entity Type:Organization
Organization Name:CENTER FOR DENTAL AESTHETICS PLLC
Other - Org Name:VEGAS SMILE SUITE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICENTA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-3789
Mailing Address - Street 1:7160 RAFAEL RIVERA WAY STE 130
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-5394
Mailing Address - Country:US
Mailing Address - Phone:702-357-4111
Mailing Address - Fax:702-924-4857
Practice Address - Street 1:7160 RAFAEL RIVERA WAY STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-5394
Practice Address - Country:US
Practice Address - Phone:702-357-4111
Practice Address - Fax:702-924-4857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty