Provider Demographics
NPI:1740366384
Name:MAHON, DAVID L (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:MAHON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10075 S EASTERN AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3974
Mailing Address - Country:US
Mailing Address - Phone:702-567-0000
Mailing Address - Fax:702-567-1777
Practice Address - Street 1:10075 S EASTERN AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3974
Practice Address - Country:US
Practice Address - Phone:702-567-0000
Practice Address - Fax:702-567-1777
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV33601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2202031Medicaid