Provider Demographics
NPI:1417394842
Name:NORTH LAS VEGAS DENTAL GROUP
Entity type:Organization
Organization Name:NORTH LAS VEGAS DENTAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TRINH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-802-3500
Mailing Address - Street 1:3376 S EASTERN AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3367
Mailing Address - Country:US
Mailing Address - Phone:702-802-3500
Mailing Address - Fax:702-802-3502
Practice Address - Street 1:3376 S EASTERN AVE STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3367
Practice Address - Country:US
Practice Address - Phone:702-802-3500
Practice Address - Fax:702-802-3502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4555122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty