Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1295349611 |
---|---|
Provider Name | Nicholas Andrew Burns |
First Address | Las Vegas, NV 89191-6600 |
Second Address | Las Vegas, NV 89191-6600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2020 |
Last Update Date | 02/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
37643551 | DRIVERS LICENSE (01) | LA |