NPIMap

Organization Active NPI

Coronado Canyon Dentistree

Doing business as Eleazar Viray Santiago Gen PTR

  • Dental Clinic/Center
  • Henderson, NV
National Provider Identifier
1043888936
Registry record updated Jun 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
CORONADO CANYON DENTISTREE
Practice address
660 S Green Valley Pkwy Ste 110
Henderson, NV 89052-0431
Phone
(702) 610-8734
NPI assigned
Jun 16, 2021
Last updated
Jun 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Eleazar SantiagoNPI 1982755898
Title
Doctor
Phone
(702) 610-8734

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

660 S Green Valley Pkwy Ste 110
Henderson, NV 89052-0431

Mailing address

660 S Green Valley Pkwy Ste 110
Henderson, NV 89052-0431
Phone (702) 610-8734

Other names 1

  • ELEAZAR VIRAY SANTIAGO GEN PTR Other name

National Provider Directory

National Provider Directory

Locations

660 S Green Valley Pkwy
Ste 110
Henderson, NV 89052
Phone (702) 610-8734

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686009600000",
    "number": "1043888936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 S GREEN VALLEY PKWY STE 110",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890520431",
            "telephone_number": "702-610-8734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 S GREEN VALLEY PKWY STE 110",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890520431",
            "telephone_number": "702-610-8734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORONADO CANYON DENTISTREE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-16",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A",
        "authorized_official_last_name": "SANTIAGO",
        "authorized_official_first_name": "ELEAZAR",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "702-610-8734"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ELEAZAR VIRAY SANTIAGO GEN PTR",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ELEAZAR VIRAY SANTIAGO GEN PTR",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.