# NEA DENTISTRY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629573266
- **Authorized official:** DR. PETER STEPHEN BONIFATTO (CLINICAL DIRECTOR)
- **Authorized official phone:** (702) 256-6001

## Contact information

- **Practice address:** 2085 VILLAGE CENTER CIR STE 140, LAS VEGAS, NV 89134-6263
- **Practice address phone:** (860) 491-6972
- **Mailing address:** 2085 VILLAGE CENTER CIR STE 140, LAS VEGAS, NV 89134-6263
- **Mailing address phone:** (702) 256-6001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 03/27/2018
- **Last updated:** 02/24/2022