Organization
KEVIN TAN DDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN TAN DDS (OWNER DENTIST)
(702) 805-1117
Entity
Organization
Contact information
Practice address
4205 S GRAND CANYON DR STE 19, LAS VEGAS, NV 89147-7152
(702) 805-1117
(702) 805-1180
Mailing address
4205 S GRAND CANYON DR STE 19, LAS VEGAS, NV 89147-7152
(702) 805-1117
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7778
DENTAL LICENSE
NV
Enumeration date
08/19/2025
Last updated
08/19/2025
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