Individual provider Active NPI

Noreen Rafik Mavrakis

  • General Practice Dentistry
  • Las Vegas, NV
National Provider Identifier
1609614171
Registry record updated Jul 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
8057 Issued in NV
Practice address
8380 W Cheyenne Ave Ste 102
Las Vegas, NV 89129-2175
Phone
(360) 536-7522
NPI assigned
Jul 18, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 8057 NV Primary

Addresses

Primary practice location

8380 W Cheyenne Ave Ste 102
Las Vegas, NV 89129-2175

Mailing address

2606 Glen Green Ave
Henderson, NV 89074-1965
Phone (702) 768-4712

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
8057NVMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1721260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721260800000",
    "number": "1609614171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2606 GLEN GREEN AVE",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890741965",
            "telephone_number": "702-768-4712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8380 W CHEYENNE AVE STE 102",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891292175",
            "telephone_number": "360-536-7522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAVRAKIS",
        "first_name": "NOREEN",
        "middle_name": "RAFIK",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-18",
        "last_updated": "2024-07-18",
        "certification_date": "2024-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NV",
            "license": "8057",
            "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 Jul 18, 2024; 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.