Organization
ELLSWORTH COX PEDIATRIC DENTISTRY LLC
Active
Other names
Anthem Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANA B. MENDOZA (OFFICE MANAGER)
(702) 459-5437
Entity
Organization
Contact information
Practice address
2843 SAINT ROSE PKWY, #100, HENDERSON, NV 89052-4813
(702) 531-5437
(702) 616-3565
Mailing address
2843 SAINT ROSE PKWY, #100, HENDERSON, NV 89052-4813
(702) 531-5437
(702) 616-3565
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
3696
NV
1223P0221X
Pediatric Dentistry
Primary
4341
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3696
STATE LICENSE NUMBER
NV
01
—
4341
STATE LICENSE NUMBER
NV
Enumeration date
10/03/2006
Last updated
11/12/2015
Update your record
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