NPIMap

Organization Active NPI

Tender Dental Bonanaza, LLC

  • General Practice Dentistry
  • Las Vegas, NV
National Provider Identifier
1124556741
Registry record updated May 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6883 Issued in NV
Legal business name
TENDER DENTAL BONANAZA, LLC
Practice address
5001 E Bonanza Rd Ste 160
Las Vegas, NV 89110-3560
Phone
(860) 325-0022
NPI assigned
May 25, 2017
Organization subpart
Yes
Parent organization
TENDER DENTAL MANAGEMENT, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 25, 2017

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

Authorized official

Name
Jong Um, DDS
Title
President
Phone
(860) 325-0022

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 6883 NV Primary

Addresses

Primary practice location

5001 E Bonanza Rd Ste 160
Las Vegas, NV 89110-3560

Mailing address

301 Commons Park S Unit 618
Stamford, CT 06902-7088
Phone (860) 491-6972

National Provider Directory

National Provider Directory
Part of
Tender Dental Management LLC

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1495670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1495670400000",
    "number": "1124556741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 COMMONS PARK S UNIT 618",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069027088",
            "telephone_number": "860-491-6972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5001 E BONANZA RD STE 160",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891103560",
            "telephone_number": "860-325-0022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TENDER DENTAL BONANAZA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TENDER DENTAL MANAGEMENT, LLC",
        "enumeration_date": "2017-05-25",
        "last_updated": "2017-05-25",
        "status": "A",
        "authorized_official_last_name": "UM",
        "authorized_official_first_name": "JONG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-325-0022",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NV",
            "license": "6883",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2017; 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.