Organization
TAHOE FACIAL PLASTIC SURGERY PLLC
Active
Other names
Tahoe Facial Plastic Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN BRADFORD M.D. (CEO)
(808) 936-3090
Entity
Organization
Contact information
Practice address
1600 MEDICAL PKWY, CARSON CITY, NV 89703-4625
(530) 721-6052
Mailing address
PO BOX 11195, ZEPHYR COVE, NV 89448-3195
(530) 721-6052
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207YS0123X
Facial Plastic Surgery Physician
Primary
—
—
208200000X
Plastic Surgery Physician
—
—
Other
Enumeration date
09/04/2024
Last updated
09/04/2024
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