Provider Demographics
NPI:1952707440
Name:PAEZ, JORGE (DDS)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:
Last Name:PAEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 S JONES BLVD
Mailing Address - Street 2:SUITE E2
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-3372
Mailing Address - Country:US
Mailing Address - Phone:702-737-3553
Mailing Address - Fax:702-873-5100
Practice Address - Street 1:4455 S JONES BLVD
Practice Address - Street 2:SUITE E2
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3372
Practice Address - Country:US
Practice Address - Phone:702-737-3553
Practice Address - Fax:702-873-5100
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2943122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist