Provider Demographics
NPI:1104432939
Name:OPEN AIRWAY LAS VEGAS LLC
Entity type:Organization
Organization Name:OPEN AIRWAY LAS VEGAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:A
Authorized Official - Last Name:ISOM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-756-8422
Mailing Address - Street 1:8845 HELENA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-3631
Mailing Address - Country:US
Mailing Address - Phone:702-756-8422
Mailing Address - Fax:
Practice Address - Street 1:7180 CASCADE VALLEY CT STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1407
Practice Address - Country:US
Practice Address - Phone:702-756-8422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No122300000XDental ProvidersDentistGroup - Multi-Specialty