Individual
SUMMER LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6780 S FORT APACHE RD STE 108, LAS VEGAS, NV 89148-5405
(725) 235-9301
Mailing address
7221 HARLOW ST, LAS VEGAS, NV 89131-2332
(415) 990-1052
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DS-041228
PA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
S2-180
NV
Other
Enumeration date
08/27/2014
Last updated
06/10/2022
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