Organization
HEAVENLY SMILES MOBILE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANET CROSSWHITE (MANAGER)
(313) 806-4786
Entity
Organization
Contact information
Practice address
6337 HAWTHORN WOODS AVE, LAS VEGAS, NV 89130-1389
(702) 445-1060
Mailing address
6337 HAWTHORN WOODS AVE, LAS VEGAS, NV 89130-1389
(702) 445-1060
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250008207
—
NV
Enumeration date
09/16/2020
Last updated
09/16/2020
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