Provider Demographics
NPI:1811748122
Name:PRISTINE DENTAL
Entity type:Organization
Organization Name:PRISTINE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:JIA
Authorized Official - Last Name:LIANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-885-6611
Mailing Address - Street 1:8612 WIND ROSE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6863
Mailing Address - Country:US
Mailing Address - Phone:626-363-5990
Mailing Address - Fax:
Practice Address - Street 1:6925 S BUFFALO DR
Practice Address - Street 2:ST 160
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113
Practice Address - Country:US
Practice Address - Phone:702-721-9698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental