Provider Demographics
NPI:1881815355
Name:MOUNTAIN VIEW DENTAL
Entity Type:Organization
Organization Name:MOUNTAIN VIEW DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:HOANG
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-227-0085
Mailing Address - Street 1:3625 S RAINBOW BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-1000
Mailing Address - Country:US
Mailing Address - Phone:702-227-0085
Mailing Address - Fax:702-227-9275
Practice Address - Street 1:3625 S RAINBOW BLVD STE 103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-1000
Practice Address - Country:US
Practice Address - Phone:702-227-0085
Practice Address - Fax:702-227-9275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3697122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty