Provider Demographics
NPI:1336541101
Name:PACIFIC DENTAL SERVICES
Entity Type:Organization
Organization Name:PACIFIC DENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:HASLAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-425-4424
Mailing Address - Street 1:4380 BLUE DIAMOND RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-7786
Mailing Address - Country:US
Mailing Address - Phone:702-425-4424
Mailing Address - Fax:
Practice Address - Street 1:4380 BLUE DIAMOND RD STE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-7786
Practice Address - Country:US
Practice Address - Phone:702-425-4424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV65311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty