Individual provider Active NPI

Stephen J Nassof, D.D.S

  • Pediatric Dentistry
  • Las Vegas, NV
National Provider Identifier
1386764306
Registry record updated Dec 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
4827T Issued in NV
Practice address
1750 Wheeler Peak Dr
Las Vegas, NV 89106-2150
Phone
(702) 272-1100
Fax
(702) 998-0675
NPI assigned
Mar 31, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 4827T NV Primary

Addresses

Primary practice location

1750 Wheeler Peak Dr
Las Vegas, NV 89106-2150

Mailing address

1750 Wheeler Peak Dr
Las Vegas, NV 89106-2150
Phone (702) 272-1100

Other identifiers 1

IdentifierTypeStateIssuer
100508592MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
4827TNVMDPediatric Dentist

NPI Registry JSON

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

{
    "created_epoch": "1175299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481587200000",
    "number": "1386764306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1750 WHEELER PEAK DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891062150",
            "telephone_number": "702-272-1100",
            "fax_number": "702-998-0675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 WHEELER PEAK DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891062150",
            "telephone_number": "702-272-1100",
            "fax_number": "702-998-0675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NASSOF",
        "first_name": "STEPHEN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-31",
        "last_updated": "2016-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NV",
            "license": "4827T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100508592",
            "state": "NV"
        }
    ],
    "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 Dec 13, 2016; 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.