Provider Demographics
NPI:1780916411
Name:VILAS BALAKRISHNA DMD PC
Entity type:Organization
Organization Name:VILAS BALAKRISHNA DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VILAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BALAKRISHNA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-998-2237
Mailing Address - Street 1:6127 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-3255
Mailing Address - Country:US
Mailing Address - Phone:702-998-2237
Mailing Address - Fax:702-243-2893
Practice Address - Street 1:6127 SOUTH RAINBOW
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3256
Practice Address - Country:US
Practice Address - Phone:702-998-2237
Practice Address - Fax:702-243-2893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5053122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty