Provider Demographics
NPI:1750980462
Name:CENTENNIAL FAMILY DENTISTRY
Entity type:Organization
Organization Name:CENTENNIAL FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:DAN
Authorized Official - Last Name:SOARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-385-7415
Mailing Address - Street 1:7890 W ANN RD STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-5214
Mailing Address - Country:US
Mailing Address - Phone:702-385-7415
Mailing Address - Fax:702-388-4386
Practice Address - Street 1:7890 W ANN RD STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-5214
Practice Address - Country:US
Practice Address - Phone:702-385-7415
Practice Address - Fax:702-388-4386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental