Provider Demographics
NPI:1184450405
Name:GO KIDS DENTAL NORTH DECATUR, LLC
Entity type:Organization
Organization Name:GO KIDS DENTAL NORTH DECATUR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DEEP
Authorized Official - Middle Name:KARAN
Authorized Official - Last Name:DHILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-522-0119
Mailing Address - Street 1:6311 N DECATUR BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-8013
Mailing Address - Country:US
Mailing Address - Phone:702-522-0119
Mailing Address - Fax:
Practice Address - Street 1:6311 N DECATUR BLVD STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-8013
Practice Address - Country:US
Practice Address - Phone:702-522-0119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GO KIDS DENTAL NORTH DECATUR, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty