Provider Demographics
NPI:1528430790
Name:ABSOLUTE DENTAL & ORTHODONTICS PRADA, PLLC
Entity type:Organization
Organization Name:ABSOLUTE DENTAL & ORTHODONTICS PRADA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-733-0888
Mailing Address - Street 1:526 S TONOPAH DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4013
Mailing Address - Country:US
Mailing Address - Phone:702-291-2031
Mailing Address - Fax:
Practice Address - Street 1:8380 W CHEYENNE AVE STE 104
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-2175
Practice Address - Country:US
Practice Address - Phone:702-733-0888
Practice Address - Fax:702-395-8718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS6-33C1223P0221X, 1223X0400X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty