# KEVIN TAN DDS LLC

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

## Provider details

- **NPI number:** 1962389106
- **Authorized official:** DR. KEVIN TAN DDS (OWNER DENTIST)
- **Authorized official phone:** (702) 805-1117

## Contact information

- **Practice address:** 4205 S GRAND CANYON DR STE 19, LAS VEGAS, NV 89147-7152
- **Practice address phone:** (702) 805-1117
- **Practice address fax:** (702) 805-1180
- **Mailing address:** 4205 S GRAND CANYON DR STE 19, LAS VEGAS, NV 89147-7152
- **Mailing address phone:** (702) 805-1117

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 08/19/2025
- **Last updated:** 08/19/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 7778 | DENTAL LICENSE | NV |