NPI 1366811747

Lone Mountain Family Dental

Organisation Preferred Provider Organization Las Vegas, NV

Practice location

Address: 4818 W Lone Mountain Rd, Las Vegas, NV 89130-2239
Phone: (702) 655-9533
Fax: (702) 655-9565

Authorised official

Name: Joshua David Etman
Title: President/ Doctor
Phone: (702) 655-9533

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 6547 (NV)

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Registry record

NPI: 1366811747
Entity type: Organization
NPI issued: 16 Sep 2015
Record last updated: 16 Sep 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.