Residental

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

RESIDENTAL

Practice address

5833 Fox Hair Street
North Las Vegas, NV 89081

Phone

(661) 886-3583

NPI assigned

May 31, 2024

Organization subpart

No

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

Authorized official

Name

Ms. Stefanie Bertram, MPH

Title

Owner

Phone

(661) 886-3583

Specialties & licenses 1

Addresses

Other names 1

• resiDENTAL Former legal business name

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

{
    "created_epoch": "1717113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718323200000",
    "number": "1891536249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5833 FOX HAIR STREET",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "89081",
            "telephone_number": "661-886-3583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5833 FOX HAIR STREET",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "89081",
            "telephone_number": "661-886-3583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESIDENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-31",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A",
        "authorized_official_last_name": "BERTRAM",
        "authorized_official_first_name": "STEFANIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "661-886-3583",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MPH"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "resiDENTAL",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Dental Clinic/Center in North Las Vegas, NV
• Providers in North Las Vegas, NV by specialty
• Dental Clinic/Center in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 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.