Provider Demographics
NPI:1952135048
Name:MORENO, CRYSTAL DENISE (RDH)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:DENISE
Last Name:MORENO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:DENISE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1426 PATHFINDER RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-3012
Mailing Address - Country:US
Mailing Address - Phone:575-680-6828
Mailing Address - Fax:
Practice Address - Street 1:1426 PATHFINDER RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-3012
Practice Address - Country:US
Practice Address - Phone:575-680-6828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV102241124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist