Provider Demographics
NPI:1891838892
Name:NEVADA DENTAL ESTHETICS, INC
Entity Type:Organization
Organization Name:NEVADA DENTAL ESTHETICS, INC
Other - Org Name:NEVADA DENTAL ESTHETICS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-737-3553
Mailing Address - Street 1:4455 S JONES BLVD
Mailing Address - Street 2:STE#2
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-3372
Mailing Address - Country:US
Mailing Address - Phone:702-737-3553
Mailing Address - Fax:702-873-5100
Practice Address - Street 1:4455 S JONES BLVD
Practice Address - Street 2:STE#2
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3372
Practice Address - Country:US
Practice Address - Phone:702-737-3553
Practice Address - Fax:702-873-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV29431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty