Provider Demographics
NPI:1609672765
Name:PURE ORTHODONTICS
Entity type:Organization
Organization Name:PURE ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:SIMISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-254-4335
Mailing Address - Street 1:6710 S FORT APACHE RD # 101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5394
Mailing Address - Country:US
Mailing Address - Phone:702-254-4335
Mailing Address - Fax:
Practice Address - Street 1:6710 S FORT APACHE RD # 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5394
Practice Address - Country:US
Practice Address - Phone:702-254-4335
Practice Address - Fax:702-254-7995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty