Active NPI
Radiant Smiles Series 4 LLC
- General Practice Dentistry
- Las Vegas, NV
National Provider Identifier
1154637890
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4725
- Legal business name
- RADIANT SMILES SERIES 4 LLC
- Practice address
- 4510 S Eastern Ave Ste 2
Las Vegas, NV 89119-6118 - Phone
- (702) 368-0911
- Fax
- (702) 734-6884
- NPI assigned
- Aug 19, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Raymond Fabian Cordero
- Title
- Director
- Phone
- (702) 368-0911
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4725 | NV | Primary |
Addresses
Primary practice location
4510 S Eastern Ave Ste 2
Las Vegas, NV 89119-6118
Mailing address
4510 S Eastern Ave Ste 2
Las Vegas, NV 89119-6118
Phone (702) 368-0911
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282176000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1282176000000",
"number": "1154637890",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4510 S EASTERN AVE STE 2",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891196118",
"telephone_number": "702-368-0911",
"fax_number": "702-734-6884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4510 S EASTERN AVE STE 2",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891196118",
"telephone_number": "702-368-0911",
"fax_number": "702-734-6884"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RADIANT SMILES SERIES 4 LLC",
"organizational_subpart": "NO",
"enumeration_date": "2010-08-19",
"last_updated": "2010-08-19",
"status": "A",
"authorized_official_last_name": "CORDERO",
"authorized_official_first_name": "RAYMOND",
"authorized_official_middle_name": "FABIAN",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "702-368-0911"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "NV",
"license": "4725",
"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 Aug 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.