Active NPI
Kanjalia Latrice Stidhum, RDH
- Dental Hygienist
- North Las Vegas, NV
National Provider Identifier
1992430029
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 102207
- Practice address
- 317 Point Loma Ave
North Las Vegas, NV 89031-7863 - Phone
- (702) 806-8222
- NPI assigned
- Jul 21, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 102207 | NV | Primary |
Addresses
Primary practice location
317 Point Loma Ave
North Las Vegas, NV 89031-7863
Mailing address
317 Point Loma Ave
North Las Vegas, NV 89031-7863
Phone (702) 806-8222
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
| License | State | Type | Specialty |
|---|---|---|---|
| 102207 | NV | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698278400000",
"number": "1992430029",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "317 POINT LOMA AVE",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890317863",
"telephone_number": "702-806-8222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "317 POINT LOMA AVE",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890317863",
"telephone_number": "702-806-8222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STIDHUM",
"first_name": "KANJALIA",
"middle_name": "LATRICE",
"credential": "RDH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-07-21",
"last_updated": "2023-10-26",
"certification_date": "2023-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dental Hygienist",
"state": "NV",
"license": "102207",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.