Provider Demographics
NPI:1447420476
Name:VERNON, JORGE A (DDS)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:A
Last Name:VERNON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:526 S TONOPAH DR
Mailing Address - Street 2:STE. 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4043
Mailing Address - Country:US
Mailing Address - Phone:702-291-2031
Mailing Address - Fax:702-366-1483
Practice Address - Street 1:3945 S MARYLAND PKWY
Practice Address - Street 2:STE. #A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7562
Practice Address - Country:US
Practice Address - Phone:702-735-3838
Practice Address - Fax:702-735-3880
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV4582T1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1447420476Medicaid