Provider Demographics
NPI:1972726214
Name:JAMES J. HONG
Entity Type:Organization
Organization Name:JAMES J. HONG
Other - Org Name:LAKESIDE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-255-1848
Mailing Address - Street 1:8821 W SAHARA AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5893
Mailing Address - Country:US
Mailing Address - Phone:702-255-1848
Mailing Address - Fax:702-256-7043
Practice Address - Street 1:8821 W SAHARA AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5893
Practice Address - Country:US
Practice Address - Phone:702-255-1848
Practice Address - Fax:702-256-7043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV35081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty