Organization
RADIANT DENTAL 1
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID C GONZALEZ (OWNER)
(702) 610-5458
Entity
Organization
Contact information
Practice address
7469 W LAKE MEAD BLVD, SUITE 270, LAS VEGAS, NV 89128-1030
(702) 312-8710
Mailing address
7469 W LAKE MEAD BLVD, SUITE 270, LAS VEGAS, NV 89128-1030
(702) 312-8710
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
4480
NV
Other
Enumeration date
11/09/2007
Last updated
11/09/2007
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