Organization
NEA DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER STEPHEN BONIFATTO (CLINICAL DIRECTOR)
(702) 256-6001
Entity
Organization
Contact information
Practice address
2085 VILLAGE CENTER CIR STE 140, LAS VEGAS, NV 89134-6263
(860) 491-6972
Mailing address
2085 VILLAGE CENTER CIR STE 140, LAS VEGAS, NV 89134-6263
(702) 256-6001
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
03/27/2018
Last updated
02/24/2022
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