Tahoe Facial Plastic Surgery PLLC

Primary specialty

Facial Plastic Surgery PhysicianTaxonomy code 207YS0123X

Legal business name

TAHOE FACIAL PLASTIC SURGERY PLLC

Doing business as

Tahoe Facial Plastic Surgery

Practice address

1600 Medical Pkwy
Carson City, NV 89703-4625

Phone

(530) 721-6052

NPI assigned

Sep 4, 2024

Last updated

Sep 4, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Benjamin Bradford, M.D.NPI 1629336128

Title

Ceo

Phone

(808) 936-3090

Specialties & licenses 4

Addresses

Other names 1

• Tahoe Facial Plastic Surgery Doing business as

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Benjamin Daniel Bradford, M.D.

  • Facial Plastic Surgery Physician
  • Stateline, NV
  • NPI 1629336128

  Dermatology

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1725408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725408000000",
    "number": "1730914433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11195",
            "city": "ZEPHYR COVE",
            "state": "NV",
            "postal_code": "894483195",
            "telephone_number": "530-721-6052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 MEDICAL PKWY",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897034625",
            "telephone_number": "530-721-6052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAHOE FACIAL PLASTIC SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-04",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A",
        "authorized_official_last_name": "BRADFORD",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "808-936-3090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tahoe Facial Plastic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Benjamin Syndergaard, D.M.D., M.S.
• David Alan Tack, M.D.
• Pamela Taecker, PTA
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• Tahoe Fracture and Orthopedic Medical Clinic, Inc
• Tahoe Fracture and Orthopedic Medical Clinic, Inc.
• Tahoe Fracture and Orthopedic Medical Clinic,Inc

• Facial Plastic Surgery Physician in Carson City, NV
• Providers in Carson City, NV by specialty
• Facial Plastic Surgery Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.