Provider Demographics
NPI:1891085684
Name:PARADISE DENTAL CLINIC
Entity Type:Organization
Organization Name:PARADISE DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZO
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATION
Authorized Official - Phone:702-272-1100
Mailing Address - Street 1:1750 WHEELER PEAK DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2150
Mailing Address - Country:US
Mailing Address - Phone:702-272-1100
Mailing Address - Fax:702-998-0675
Practice Address - Street 1:1750 WHEELER PEAK DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2150
Practice Address - Country:US
Practice Address - Phone:702-272-1100
Practice Address - Fax:702-998-0675
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S CARE INTERNATIONAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty