Provider Demographics
NPI:1295334340
Name:RACHEL MISMAS DDS LLC
Entity type:Organization
Organization Name:RACHEL MISMAS DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MISMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-334-6058
Mailing Address - Street 1:7035 W ANN RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3867
Mailing Address - Country:US
Mailing Address - Phone:702-396-2929
Mailing Address - Fax:702-658-6435
Practice Address - Street 1:7035 W ANN RD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3867
Practice Address - Country:US
Practice Address - Phone:702-396-2929
Practice Address - Fax:702-658-6435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1619015831OtherNPI