# TAHOE FACIAL PLASTIC SURGERY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Tahoe Facial Plastic Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730914433
- **Authorized official:** DR. BENJAMIN BRADFORD M.D. (CEO)
- **Authorized official phone:** (808) 936-3090

## Contact information

- **Practice address:** 1600 MEDICAL PKWY, CARSON CITY, NV 89703-4625
- **Practice address phone:** (530) 721-6052
- **Mailing address:** PO BOX 11195, ZEPHYR COVE, NV 89448-3195
- **Mailing address phone:** (530) 721-6052

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207N00000X | Dermatology Physician | — | NULL | — |
| 207N00000X | Dermatology Physician | — | — | — |
| 207ND0101X | MOHS-Micrographic Surgery Physician | — | NULL | — |
| 207ND0101X | MOHS-Micrographic Surgery Physician | — | — | — |
| 207YS0123X | Facial Plastic Surgery Physician | — | NULL | Yes |
| 207YS0123X | Facial Plastic Surgery Physician | — | — | Yes |
| 208200000X | Plastic Surgery Physician | — | NULL | — |
| 208200000X | Plastic Surgery Physician | — | — | — |

## Other

- **Enumeration date:** 09/04/2024
- **Last updated:** 09/04/2024