Provider Demographics
NPI:1194128298
Name:ERIC AVITIA DDS, LLC
Entity type:Organization
Organization Name:ERIC AVITIA DDS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:AVITIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-513-9326
Mailing Address - Street 1:7945 W SAHARA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7908
Mailing Address - Country:US
Mailing Address - Phone:702-363-0421
Mailing Address - Fax:702-363-8951
Practice Address - Street 1:7945 W SAHARA AVE STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7908
Practice Address - Country:US
Practice Address - Phone:702-363-0421
Practice Address - Fax:702-363-8951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV56091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty