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Organization
TAHOE FACIAL PLASTIC SURGERY PLLC
Active
Organization
TAHOE FACIAL PLASTIC SURGERY PLLC
Active
Other names
Tahoe Facial Plastic Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN BRADFORD M.D. (CEO)
(808) 936-3090
Entity
Organization
Contact information
Practice address
1600 MEDICAL PKWY, CARSON CITY, NV 89703-4625
(530) 721-6052
Mailing address
PO BOX 11195, ZEPHYR COVE, NV 89448-3195
(530) 721-6052
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
NULL
207N00000X
Dermatology Physician
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
NULL
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207YS0123X
Facial Plastic Surgery Physician
Primary
—
NULL
207YS0123X
Facial Plastic Surgery Physician
Primary
—
—
208200000X
Plastic Surgery Physician
—
NULL
208200000X
Plastic Surgery Physician
—
—
Other
Enumeration date
09/04/2024
Last updated
09/04/2024
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