Provider Demographics
NPI:1336599125
Name:ABITTAN, AIMEE NICOLE (DMD)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:NICOLE
Last Name:ABITTAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 S RANCHO DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-4451
Mailing Address - Country:US
Mailing Address - Phone:702-291-2031
Mailing Address - Fax:702-984-7566
Practice Address - Street 1:3405 MARKET ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-8021
Practice Address - Country:US
Practice Address - Phone:775-461-1180
Practice Address - Fax:775-461-1181
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6808122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1336599125Medicaid