Provider Demographics
NPI:1962260034
Name:HILLSIDE DENTAL LTD
Entity type:Organization
Organization Name:HILLSIDE DENTAL LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-895-7799
Mailing Address - Street 1:6090 S. FORT APACHE
Mailing Address - Street 2:STE 120 HILLSIDE DENTAL
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148
Mailing Address - Country:US
Mailing Address - Phone:702-895-7799
Mailing Address - Fax:702-895-7192
Practice Address - Street 1:6090 S. FORT APACHE
Practice Address - Street 2:STE 120 HILLSIDE DENTAL
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148
Practice Address - Country:US
Practice Address - Phone:702-895-7799
Practice Address - Fax:702-895-7192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty