Provider Demographics
NPI:1740650118
Name:MUGLESTON GREEN VALLEY MODERN DENTISTRY, PC
Entity type:Organization
Organization Name:MUGLESTON GREEN VALLEY MODERN DENTISTRY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CODY
Authorized Official - Middle Name:P
Authorized Official - Last Name:MUGLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-465-8187
Mailing Address - Street 1:17000 RED HILL AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5626
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:949-474-1495
Practice Address - Street 1:4301 E SUNSET RD
Practice Address - Street 2:100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2238
Practice Address - Country:US
Practice Address - Phone:702-465-8187
Practice Address - Fax:702-558-9278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty