Provider Demographics
NPI:1366775389
Name:PLANET DENTAL INC
Entity type:Organization
Organization Name:PLANET DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-457-5335
Mailing Address - Street 1:2755 S NELLIS BLVD
Mailing Address - Street 2:STE 12
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-7549
Mailing Address - Country:US
Mailing Address - Phone:702-457-5335
Mailing Address - Fax:702-457-3848
Practice Address - Street 1:4570 N RANCHO DR
Practice Address - Street 2:STE 2
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3430
Practice Address - Country:US
Practice Address - Phone:702-656-9497
Practice Address - Fax:702-656-9138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4603122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty