NPIMap

Organization Active NPI

Boulder Dental Group, LLC

  • General Practice Dentistry
  • Las Vegas, NV
National Provider Identifier
1245677152
Registry record updated May 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
S6-81 Issued in NY
Legal business name
BOULDER DENTAL GROUP, LLC
Practice address
6325 E Russell Rd
#100
Las Vegas, NV 89122-7069
Phone
(702) 227-6588
Fax
(702) 382-4469
NPI assigned
May 31, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2013

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

Authorized official

Name
Gurbrinder Dhillon
Title
Owner
Phone
(702) 435-5015

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X S6-81 NY Primary

Addresses

Primary practice location

6325 E Russell Rd
#100
Las Vegas, NV 89122-7069

Mailing address

526 S Tonopah Dr
#200
Las Vegas, NV 89106-4043
Phone (702) 435-5015

Other names 1

  • Absolute Dental Kids & Braces Doing business as

National Provider Directory

National Provider Directory

Locations

6325 E Russell Rd
Ste 100
Las Vegas, NV 89122
Phone (702) 227-6588

NPI Registry JSON

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

{
    "created_epoch": "1369958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369958400000",
    "number": "1245677152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "526 S TONOPAH DR",
            "address_2": "#200",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064043",
            "telephone_number": "702-435-5015",
            "fax_number": "702-366-1483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6325 E RUSSELL RD",
            "address_2": "#100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891227069",
            "telephone_number": "702-227-6588",
            "fax_number": "702-382-4469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDER DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-31",
        "last_updated": "2013-05-31",
        "status": "A",
        "authorized_official_last_name": "DHILLON",
        "authorized_official_first_name": "GURBRINDER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-435-5015"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "S6-81",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Absolute Dental Kids & Braces",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 31, 2013; 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.