Coronado Canyon Dentistree | |
660 S Green Valley Pkwy Ste 110 Henderson NV 89052-0431 | |
(702) 610-8734 | |
Not Available |
Full Name | Coronado Canyon Dentistree |
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Speciality | Clinic/Center |
Location | 660 S Green Valley Pkwy Ste 110, Henderson, Nevada |
Authorized Official Name and Position | Eleazar Santiago (DOCTOR) |
Authorized Official Contact | 7026108734 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Coronado Canyon Dentistree 660 S Green Valley Pkwy Ste 110 Henderson NV 89052-0431 Ph: (702) 610-8734 | Coronado Canyon Dentistree 660 S Green Valley Pkwy Ste 110 Henderson NV 89052-0431 Ph: (702) 610-8734 |
NPI Number | 1043888936 |
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Provider Enumeration Date | 06/16/2021 |
Last Update Date | 06/06/2023 |
Medicare PECOS PAC ID | 3375933906 |
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Medicare Enrollment ID | O20211214000545 |
Identifier | Type | State | Issuer |
---|---|---|---|
1043888936 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Secondary |
261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
Provider Name | Eleazar Santiago |
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Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1982755898 PECOS PAC ID: 0840610333 Enrollment ID: I20201022001133 |
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