Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | S6-207 | NV |
NPI | 1013577584 |
---|---|
Provider Name | Nathan Lo |
First Address | Henderson, NV 89052-4864 |
Second Address | Las Vegas, NV 89147-0441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2019 |
Last Update Date | 23/08/2021 |