Provider Demographics
NPI:1518109396
Name:LAC DENTAL LTD
Entity type:Organization
Organization Name:LAC DENTAL LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:V
Authorized Official - Last Name:LAC
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-672-0628
Mailing Address - Street 1:10170 W TROPICANA AVE
Mailing Address - Street 2:SUITE 155
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8465
Mailing Address - Country:US
Mailing Address - Phone:702-248-0081
Mailing Address - Fax:702-248-7123
Practice Address - Street 1:10170 W TROPICANA AVE
Practice Address - Street 2:SUITE 155
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8465
Practice Address - Country:US
Practice Address - Phone:702-248-0081
Practice Address - Fax:702-248-7123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4561261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1606724OtherUNITED CONCORDIA
NV100503172Medicaid