Provider Demographics
NPI:1376008193
Name:LIFE DENTISTRY - DR DUFF, PLLC
Entity type:Organization
Organization Name:LIFE DENTISTRY - DR DUFF, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MASON
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-816-9615
Mailing Address - Street 1:10670 DEAN MARTIN DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-3597
Mailing Address - Country:US
Mailing Address - Phone:702-680-1120
Mailing Address - Fax:
Practice Address - Street 1:10670 DEAN MARTIN DR.
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141
Practice Address - Country:US
Practice Address - Phone:702-680-1120
Practice Address - Fax:702-680-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental