General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
BATTLE MOUNTAIN
#017060
Battle Mountain Dental
100 Carson Road, Ste 1
Battle Mountain, NV 89820
(775) 635-3300
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# 5083 Thompson, William
NPI: 1558446260 LIC: 5083
BOULDER CITY
#017082
Children's Dentistry
1651 Nevada Hwy
Boulder City, NV 89005
(702) 489-0810
English, Spanish
M-F 9am - 5pm
# 4334 Barbin, Francesca
NPI: 1689758252 LIC: 4334
# 6866 Borghei, Sarah
NPI: 1447796636 LIC: 6866
# 6754 Campbell, Amanda
NPI: 1831504612 LIC: 6754
# 5929 Delisle, Steven
NPI: 1639329337 LIC: 5929
# 6752 Delisle, Nicholas
NPI: 1073963385 LIC: 6752
# 6024 Gandotra, Vivek
NPI: 1013054931 LIC: 6024
# 6831 Kim, Eugene
NPI: 1306361845 LIC: 6831
# 5606 Lebroke, Ronald
NPI: 1336310309 LIC: 5606
# 6549 Lee, Steven
NPI: 1538569389 LIC: 6549
# 6830CA Lim, Jason
NPI: 1184980955 LIC: 6830CA
# 6659 Mismas, Rachel
NPI: 1619015831 LIC: 6659
# 6841 Nguyen, Jack
NPI: 1700323839 LIC: 6841
# 6925 Patel, Payal
NPI: 1790149193 LIC: 6925
# 3080 Richens, Bradley
NPI: 1437163078 LIC: 3080
# S6-120 Salar, Behnam
NPI: 1629326400 LIC: S6-120
# 6463 Truong, Vanna
NPI: 1629400130 LIC: 6463
# 7137 Wong, Joel
NPI: 1962987602 LIC: 7137
# 2901022360 Zeitoun, Ali
NPI: 1346761368 LIC: 2901022360
CARSON CITY
#016682
Absolute Dental & Orthodontics
956 Topsy Lane, Ste 103
Carson City, NV 89705
(775) 884-4888
English, Spanish
M-F 8am - 5pm
# 6808NV Abittan, Aimee
NPI: 1336599125 LIC: 6808NV
# 6855 Albander, Lina
NPI: 1326599275 LIC: 6855
# 6656OK Alford, Jacqueline
NPI: 1275935702 LIC: 6656OK
# 7158 Carpenter, Clifton
NPI: 1548613185 LIC: 7158
# 6874NV Futch, Scott
NPI: 1003987744 LIC: 6874NV
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# 6803 Nygren, Amy
NPI: 1447794854 LIC: 6803
# 62428 Pham, Jeremy
NPI: 1679912281 LIC: 62428
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
# 6163NV Silvaroli, Patrick
NPI: 1699096701 LIC: 6163NV
# 7095NV Vial, Nicolette
NPI: 1679069645 LIC: 7095NV
# 5893 Vu, Trung
NPI: 1548474760 LIC: 5893
#020339
Carson Kids Dental
1621 E William Street, Ste G
Carson City, NV 89701
(775) 790-7733
English
M-F 8am - 5pm
# 6681 Todd, Chelsie
NPI: 1376926980 LIC: 6681
#007109
Courtesy Dental & Orthodontics -
Carson City
307 W Winnie Ln, Ste 2
Carson City, NV 89703
(775) 885-2323
Spanish
M 7am - 4pm, T 7am - 3pm
W-F 7am-3pm
# 6740 Atwal, Parminder
NPI: 1174938039 LIC: 6740
# 6336 Basta, Trevor
NPI: 1962753996 LIC: 6336
# 5098 Curtis, Russell
NPI: 1386761633 LIC: 5098
# 6675NV Dapra Jr., David
NPI: 1447633474 LIC: 6675NV
# 6368 Hashtroudi, Saman
NPI: 1740520188 LIC: 6368
# 6467 Myrin, Christina
NPI: 1881025476 LIC: 6467
#015343
First Care Dental, Inc.
314 W 5Th Street
Carson City, NV 89703
(775) 882-1111
English, Chinese Mandarin, Spanish,
Vietnamese
M-Th 8am - 5pm
# 4409 Yen, Jennifer
NPI: 1679648919 LIC: 4409
CEDAR CITY
#016898
Cedar View Pediatric Dentistry
1251 N. Northfield Rd Ste 201
Cedar City, UT 84721
(435) 586-8188
English, Spanish, German
M-T 8am-4pm
W-Th 8am-4pm
# 6335935-9921 Albrecht, Tyler
NPI: 1063530269 LIC: 6335935-9921
# 5944576-9923 Grieve, Brandon
NPI: 1992889448 LIC: 5944576-9923
# 8982123-9923 Higbee, Jeffrey
NPI: 1942565486 LIC: 8982123-9923
#016846
Complete Family Dental
110 W 1325 N Ste 125
Cedar City, UT 84721
(435) 586-3884
English, Spanish
M 9am - 4pm, T 9am - 5pm
W-Th 9am-5pm
# 6259409-9921 Ludlow, Jeremy
NPI: 1902942147 LIC: 6259409-9921
ELKO
#015431
Any Day Dental - Elko
2575 N 5Th Street, Ste A
Elko, NV 89801
(775) 738-9666
English, Spanish
M-F 8am - 6pm
# 4938 Cressman, Clark
NPI: 1457524175 LIC: 4938
# 4167 Kirkland, Travis
NPI: 1992860415 LIC: 4167
# GR6495TA Osterhoudt, Darrell
NPI: 1578755948 LIC: GR6495TA
# 3224 Willardsen, James
NPI: 1013080274 LIC: 3224
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 1 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
#FQHC007050
Elko Family Medical & Dental
Center
762 14Th St
Elko, NV 89801
(844) 227-6867
English, Spanish
M-T 7am-6pm
W 7am-6am, Th 7am-6pm
# 6713 Egbert, Daniel
NPI: 1578975397 LIC: 6713
# 6134 Putnam, Bryce
NPI: 1205126414 LIC: 6134
# 2644NV Shin, Eunsook
NPI: 1881794204 LIC: 2644NV
FALLON
#016792
Fallon Family Dental Care LLC
300 West A Street
Fallon, NV 89406
(775) 423-5213
English, Spanish
M-F 8am - 5pm
# 5894 Jaques, Cary
NPI: 1326244757 LIC: 5894
FERNLEY
#014469
Toothfairy Pediatric Dental
1420 Us Hwy 95A North Ste #2
Fernley, NV 89408
(775) 909-4824
English, Spanish
M-F 8am - 5pm
# 6865 Cope, Austin
NPI: 1063893659 LIC: 6865
# 0767 Davies, Michael
NPI: 1649347519 LIC: 0767
# 6683 Dinh, Megan-Vinh
NPI: 1225408701 LIC: 6683
# 6376NV Horgan, Bryan
NPI: 1235487745 LIC: 6376NV
# 6382 Jensen, James
NPI: 1134568876 LIC: 6382
# S6-120 Salar, Behnam
NPI: 1629326400 LIC: S6-120
# 6463 Truong, Vanna
NPI: 1629400130 LIC: 6463
# 6800 Wildman, Payden
NPI: 1265885719 LIC: 6800
GARDNERVILLE
#016646
Just Smiles Dental
1328 Us Hwy 395 North, Ste 305
Gardnerville, NV 89410
(775) 782-7654
English, Spanish
M 8am - 4pm, T 8am - 5pm
W 8am-5pm, Th 8am-4pm, F 8am-5pm
# 5870 Mcgruder, Keith
NPI: 1801983887 LIC: 5870
#014468
Toothfairy Pediatric Dental
1485 Us Hwy 395 N
Gardnerville, NV 89410
(775) 971-4252
English, Spanish
M-F 8am - 5pm
# 6683 Dinh, Megan-Vinh
NPI: 1225408701 LIC: 6683
# 6382 Jensen, James
NPI: 1134568876 LIC: 6382
# S6-120 Salar, Behnam
NPI: 1629326400 LIC: S6-120
# 6463 Truong, Vanna
NPI: 1629400130 LIC: 6463
HAWTHORNE
#016840
Bruce Dow, DDS
155 South C St.
Hawthorne, NV 89415
(775) 945-2438
English
M-T 8am-5pm
W 11am-4pm, Th 8am-5pm, F 8am-1pm
# 2137 Dow, Bruce
NPI: 1013931708 LIC: 2137
HENDERSON
#007202
Anthem Pediatric Dentistry
10400 S. Eastern Ave
Henderson, NV 89052
(702) 531-5437
Spanish
M-T 8am-5pm
W-Th 8am-5pm
# 2165 Kinner, Jeff
NPI: 1275579120 LIC: 2165
#007058
Apple Dental
301 N. Pecos Rd, Ste F
Henderson, NV 89074
(702) 558-4488
English, Korean, Spanish
M-T 9am-6pm
Th-F 9am-6pm
# 2887 Paik, Dan
NPI: 1023156312 LIC: 2887
#016521
Children's Dentistry and
Orthodontics
2571 Anthem Village Dr Ste 5
Henderson, NV 89052
(702) 903-1973
English, Spanish
M-T 8am-4pm
Th-F 8am-4pm
S 8am - 4pm
# 4334 Barbin, Francesca
NPI: 1689758252 LIC: 4334
# 6866 Borghei, Sarah
NPI: 1447796636 LIC: 6866
# 6754 Campbell, Amanda
NPI: 1831504612 LIC: 6754
# 5929 Delisle, Steven
NPI: 1639329337 LIC: 5929
# 6752 Delisle, Nicholas
NPI: 1073963385 LIC: 6752
# 6024 Gandotra, Vivek
NPI: 1013054931 LIC: 6024
# 6831 Kim, Eugene
NPI: 1306361845 LIC: 6831
# 5606 Lebroke, Ronald
NPI: 1336310309 LIC: 5606
# 6549 Lee, Steven
NPI: 1538569389 LIC: 6549
# 6830CA Lim, Jason
NPI: 1184980955 LIC: 6830CA
# 6659 Mismas, Rachel
NPI: 1619015831 LIC: 6659
# 6841 Nguyen, Jack
NPI: 1700323839 LIC: 6841
# 6925 Patel, Payal
NPI: 1790149193 LIC: 6925
# 3080 Richens, Bradley
NPI: 1437163078 LIC: 3080
# S6-120 Salar, Behnam
NPI: 1629326400 LIC: S6-120
# 6463 Truong, Vanna
NPI: 1629400130 LIC: 6463
# 7137 Wong, Joel
NPI: 1962987602 LIC: 7137
# 2901022360 Zeitoun, Ali
NPI: 1346761368 LIC: 2901022360
#007207
Coast Dental - Henderson
2660 Windmill Pkwy
Henderson, NV 89074
(702) 990-2960
Spanish
M-F 8am - 5pm
# 7010 Ellsworth, Evan
NPI: 1003314535 LIC: 7010
# 32697 Patel, Rahul
NPI: 1063969152 LIC: 32697
#020197
Cosmic Kids Dental
390 N. Stephanie St., Ste. 104
Henderson, NV 89014
(702) 947-7700
Chinese Mandarin, English,
Cantonese Chinese, Portuguese,
Spanish
M-Th 8am - 5pm
# S6-165 Hon, Larry
NPI: 1114378866 LIC: S6-165
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 2 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
#007150
Courtesy Dental & Orthodontics -
Henderson
2811 N Green Valley Pkwy
Henderson, NV 89014
(702) 434-2219
Spanish, Tagalog
M-F 8am - 4pm
# 6740 Atwal, Parminder
NPI: 1174938039 LIC: 6740
# 6336 Basta, Trevor
NPI: 1962753996 LIC: 6336
# 6675NV Dapra Jr., David
NPI: 1447633474 LIC: 6675NV
# 6368 Hashtroudi, Saman
NPI: 1740520188 LIC: 6368
# 6467 Myrin, Christina
NPI: 1881025476 LIC: 6467
#021294
First Bite Pediatric Dentistry
866 Seven Hills Drive Ste #102
Henderson, NV 89052
(702) 805-8185
English, Spanish
M-F 9am - 6pm
# S6-108 Manuel, Renalie
NPI: 1902952070 LIC: S6-108
# S6-139 Nguyen, Peter
NPI: 1962885848 LIC: S6-139
#007190
H & M Dental
4401 East Sunset Road, Ste 3
Henderson, NV 89014
(702) 735-5297
Spanish, Tagalog, Other, Vietnamese
M 8am - 5pm, T 8am - 7pm
W-Th 8am-5pm
S 8am - 2pm
# 6324 Miller, George
NPI: 1114276847 LIC: 6324
# 4922 Nguyen, Hien
NPI: 1730274044 LIC: 4922
#016700
Mint Dental & Orthodontics
375 N. Stephanie Bldg 6 #611
Henderson, NV 89014
(702) 990-7336
English, Spanish
M-F 8am - 5pm
# 7058 Chang, Ning
NPI: 1003265091 LIC: 7058
# 2387 Clark, Dennis
NPI: 1871515643 LIC: 2387
# S6-118 Ezeanolue, Bibiana
NPI: 1356570998 LIC: S6-118
# 6131NV Tounian, Arvin
NPI: 1467639005 LIC: 6131NV
# 5586 Tran, My
NPI: 1184882847 LIC: 5586
# 6773 Viravongsa, Christopher
NPI: 1982056818 LIC: 6773
#008608
Southridge Dental
1000 Wigwam Pkwy Ste 120
Henderson, NV 89074
(702) 777-4700
English
M-Th 8am - 5pm
# 5105 Hahn, Byronn
NPI: 1336244979 LIC: 5105
#008439
Wirig Orthodontics
375 N Stephanie St, Ste 211
Henderson, NV 89014
(702) 454-1008
English, Spanish
M-F 9am - 5pm
# S6-96 Bybee, Ryan
NPI: 1457541997 LIC: S6-96
# 6539 Wirig, Spencer
NPI: 1801948484 LIC: 6539
LAS VEGAS
#007144
A C Dental, LCC
1520 N Eastern Ave, Ste 105
Las Vegas, NV 89101
(702) 633-6339
Vietnamese, Spanish
M-Th 10am - 7pm
# 4817 Do, Dominic
NPI: 1679660484 LIC: 4817
# 3776 Le, Tuan
NPI: 1982788261 LIC: 3776
# 6941 Tran, Halan
NPI: 1538682752 LIC: 6941
# 6463NV Truong, Nhan (Ben)
NPI: 1013940915 LIC: 6463NV
#012546
A Plus Dental Group, LLC
2285 E. Flamingo Rd, Ste #101
Las Vegas, NV 89119
(702) 522-9192
English, Farsi, Spanish
M-F 9am - 6pm
# 6558 Goshimea, Dawit
NPI: 1821497900 LIC: 6558
# 6794 Jimenez-Marquez, Jorge
NPI: 1639529704 LIC: 6794
# 29704TX Khosousi, Mohammad
NPI: 1124394069 LIC: 29704TX
# 6365 Khossoosi, Leila
NPI: 1922358944 LIC: 6365
# 3338 Koster, Markus
NPI: 1386862985 LIC: 3338
#017456
A Plus Dental Group, LLC
4226 S. Durango Drive, Ste 103
Las Vegas, NV 89147
(702) 800-7676
English, Spanish
M-F 9am - 5pm
# 6558 Goshimea, Dawit
NPI: 1821497900 LIC: 6558
# 6794 Jimenez-Marquez, Jorge
NPI: 1639529704 LIC: 6794
# 29704TX Khosousi, Mohammad
NPI: 1124394069 LIC: 29704TX
# 6365 Khossoosi, Leila
NPI: 1922358944 LIC: 6365
# 3338 Koster, Markus
NPI: 1386862985 LIC: 3338
#007259
Absolute Dental & Orthodontics
8380 W. Cheyenne Ave Ste 104
Las Vegas, NV 89129
(702) 733-0888
English, Spanish
M-F 8am - 5pm
# 5802 Abdou, Mary
NPI: 1689805939 LIC: 5802
# 5695 Anwar, Lubna
NPI: 1326209586 LIC: 5695
# 31436 Browne, Morgan
NPI: 1316316706 LIC: 31436
# S6-164 Cao, Michael
NPI: 1679020622 LIC: S6-164
# 6824 Culpepper, Marah
NPI: 1366992232 LIC: 6824
# 32232 Dao, Alexander
NPI: 1881148344 LIC: 32232
# 32909 Dao, Minhquan
NPI: 1477082717 LIC: 32909
# 6962 Davidowitz, Rachelle
NPI: 1629594940 LIC: 6962
# S6-118 Ezeanolue, Bibiana
NPI: 1356570998 LIC: S6-118
# 6328 Farokh, Samira
NPI: 1497091367 LIC: 6328
# 51777 Fellars, David
NPI: 1659555076 LIC: 51777
# 3732 Fu, Suzan
NPI: 1144238049 LIC: 3732
# 6063 Guideng, Romulo
NPI: 1174824148 LIC: 6063
# 6530 Han, Irene
NPI: 1639569064 LIC: 6530
# 7124NV Hess, Trevor
NPI: 1831507482 LIC: 7124NV
# S6-165 Hon, Larry
NPI: 1114378866 LIC: S6-165
# 5814 Huynh, James
NPI: 1144452996 LIC: 5814
# 5477 Khairah, Gurpreet
NPI: 1659599280 LIC: 5477
# 6942 Koscinski, Matt
NPI: 1093242232 LIC: 6942
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 3 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
# 5038 Landron, Joan
NPI: 1003892126 LIC: 5038
# S6-108 Manuel, Renalie
NPI: 1902952070 LIC: S6-108
# 3716 Mcintosh, Vivi
NPI: 1124238662 LIC: 3716
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# 25566 Nghiem, Audrey
NPI: 1700190790 LIC: 25566
# 4886 Nguyen, Man
NPI: 1760562557 LIC: 4886
# 7133 Nielson, France
NPI: 1083924971 LIC: 7133
# 5713 Patel, Sarika
NPI: 1346406808 LIC: 5713
# D07110 Peterson, Steven
NPI: 1477600666 LIC: D07110
# 6931 Petrie, Natasha
NPI: 1255795928 LIC: 6931
# 5483 Phan, Dawna
NPI: 1417086661 LIC: 5483
# 4415 Porter, Stansby
NPI: 1851425482 LIC: 4415
# 101448 Pour, Hamid
NPI: 1174043764 LIC: 101448
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
# 7107NV Rezapour, Noura
NPI: 1194205625 LIC: 7107NV
# 7132 Sanikop-Kori, Priyanka
NPI: 1780155820 LIC: 7132
# 6697 Saparam, Nischal
NPI: 1689838005 LIC: 6697
# 7109 Shah, Rahi
NPI: 1053897660 LIC: 7109
# 6894 Shahrokh, Pouyan
NPI: 1013354927 LIC: 6894
# 6949 Sharma, Akanksha
NPI: 1164944278 LIC: 6949
# S6-130 Shroff, Sulabh
NPI: 1811284243 LIC: S6-130
# 4493 Spengler, Sandra
NPI: 1144232976 LIC: 4493
# S5-50C Trinh, Owen
NPI: 1164806907 LIC: S5-50C
# 6776 Vann, Stephen
NPI: 1003035437 LIC: 6776
# 4582 Vernon, Jorge
NPI: 1447420476 LIC: 4582
# 6773 Viravongsa, Christopher
NPI: 1982056818 LIC: 6773
# 5090 Wilson, Jeremy
NPI: 1023186095 LIC: 5090
# 6509 Yap, Kimberly
NPI: 1255615803 LIC: 6509
#007260
Absolute Dental & Orthodontics
9400 S Eastern Ave Ste 101
Las Vegas, NV 89123
(702) 456-0009
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
S 9am - 3pm
# 5802 Abdou, Mary
NPI: 1689805939 LIC: 5802
# 5695 Anwar, Lubna
NPI: 1326209586 LIC: 5695
# 31436 Browne, Morgan
NPI: 1316316706 LIC: 31436
# S6-164 Cao, Michael
NPI: 1679020622 LIC: S6-164
# 32232 Dao, Alexander
NPI: 1881148344 LIC: 32232
# 32909 Dao, Minhquan
NPI: 1477082717 LIC: 32909
# 6962 Davidowitz, Rachelle
NPI: 1629594940 LIC: 6962
# 6328 Farokh, Samira
NPI: 1497091367 LIC: 6328
# 51777 Fellars, David
NPI: 1659555076 LIC: 51777
# 6063 Guideng, Romulo
NPI: 1174824148 LIC: 6063
# 6530 Han, Irene
NPI: 1639569064 LIC: 6530
# 7124NV Hess, Trevor
NPI: 1831507482 LIC: 7124NV
# S6-165 Hon, Larry
NPI: 1114378866 LIC: S6-165
# 5814 Huynh, James
NPI: 1144452996 LIC: 5814
# 5477 Khairah, Gurpreet
NPI: 1659599280 LIC: 5477
# 5038 Landron, Joan
NPI: 1003892126 LIC: 5038
# S6-108 Manuel, Renalie
NPI: 1902952070 LIC: S6-108
# 3716 Mcintosh, Vivi
NPI: 1124238662 LIC: 3716
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# 25566 Nghiem, Audrey
NPI: 1700190790 LIC: 25566
# 4886 Nguyen, Man
NPI: 1760562557 LIC: 4886
# 7133 Nielson, France
NPI: 1083924971 LIC: 7133
# 5713 Patel, Sarika
NPI: 1346406808 LIC: 5713
# D07110 Peterson, Steven
NPI: 1477600666 LIC: D07110
# 6931 Petrie, Natasha
NPI: 1255795928 LIC: 6931
# 5483 Phan, Dawna
NPI: 1417086661 LIC: 5483
# 4415 Porter, Stansby
NPI: 1851425482 LIC: 4415
# 101448 Pour, Hamid
NPI: 1174043764 LIC: 101448
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
# 7107NV Rezapour, Noura
NPI: 1194205625 LIC: 7107NV
# 6697 Saparam, Nischal
NPI: 1689838005 LIC: 6697
# 6894 Shahrokh, Pouyan
NPI: 1013354927 LIC: 6894
# 6949 Sharma, Akanksha
NPI: 1164944278 LIC: 6949
# 4493 Spengler, Sandra
NPI: 1144232976 LIC: 4493
# S5-50C Trinh, Owen
NPI: 1164806907 LIC: S5-50C
# 6776 Vann, Stephen
NPI: 1003035437 LIC: 6776
# 6773 Viravongsa, Christopher
NPI: 1982056818 LIC: 6773
# 5090 Wilson, Jeremy
NPI: 1023186095 LIC: 5090
# 6509 Yap, Kimberly
NPI: 1255615803 LIC: 6509
#007261
Absolute Dental & Orthodontics
3830 E. Flamingo Rd Ste E 2
Las Vegas, NV 89121
(702) 435-3888
English, Spanish
M-T 9am-6pm
W-Th 9am-6pm
# 5802 Abdou, Mary
NPI: 1689805939 LIC: 5802
# 5695 Anwar, Lubna
NPI: 1326209586 LIC: 5695
# 31436 Browne, Morgan
NPI: 1316316706 LIC: 31436
# S6-164 Cao, Michael
NPI: 1679020622 LIC: S6-164
# 6824 Culpepper, Marah
NPI: 1366992232 LIC: 6824
# 32232 Dao, Alexander
NPI: 1881148344 LIC: 32232
# 32909 Dao, Minhquan
NPI: 1477082717 LIC: 32909
# 6962 Davidowitz, Rachelle
NPI: 1629594940 LIC: 6962
# 6328 Farokh, Samira
NPI: 1497091367 LIC: 6328
# 51777 Fellars, David
NPI: 1659555076 LIC: 51777
# 6063 Guideng, Romulo
NPI: 1174824148 LIC: 6063
# 7124NV Hess, Trevor
NPI: 1831507482 LIC: 7124NV
# S6-165 Hon, Larry
NPI: 1114378866 LIC: S6-165
# 5814 Huynh, James
NPI: 1144452996 LIC: 5814
# 5477 Khairah, Gurpreet
NPI: 1659599280 LIC: 5477
# 5038 Landron, Joan
NPI: 1003892126 LIC: 5038
# S6-108 Manuel, Renalie
NPI: 1902952070 LIC: S6-108
# 3716 Mcintosh, Vivi
NPI: 1124238662 LIC: 3716
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# 25566 Nghiem, Audrey
NPI: 1700190790 LIC: 25566
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 4 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
# 4886 Nguyen, Man
NPI: 1760562557 LIC: 4886
# 7133 Nielson, France
NPI: 1083924971 LIC: 7133
# 5713 Patel, Sarika
NPI: 1346406808 LIC: 5713
# D07110 Peterson, Steven
NPI: 1477600666 LIC: D07110
# 6931 Petrie, Natasha
NPI: 1255795928 LIC: 6931
# 5483 Phan, Dawna
NPI: 1417086661 LIC: 5483
# 4415 Porter, Stansby
NPI: 1851425482 LIC: 4415
# 101448 Pour, Hamid
NPI: 1174043764 LIC: 101448
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
# 7107NV Rezapour, Noura
NPI: 1194205625 LIC: 7107NV
# 6697 Saparam, Nischal
NPI: 1689838005 LIC: 6697
# 6894 Shahrokh, Pouyan
NPI: 1013354927 LIC: 6894
# 6949 Sharma, Akanksha
NPI: 1164944278 LIC: 6949
# 4493 Spengler, Sandra
NPI: 1144232976 LIC: 4493
# S5-50C Trinh, Owen
NPI: 1164806907 LIC: S5-50C
# 6776 Vann, Stephen
NPI: 1003035437 LIC: 6776
# 6773 Viravongsa, Christopher
NPI: 1982056818 LIC: 6773
# 5090 Wilson, Jeremy
NPI: 1023186095 LIC: 5090
# 6509 Yap, Kimberly
NPI: 1255615803 LIC: 6509
#007266
Absolute Dental & Orthodontics
860 S. Rancho Dr, Ste 3
Las Vegas, NV 89106
(702) 878-0808
English, Spanish
T 9am - 5pm
W-F 9am-5pm
S 9am - 3pm
# 5802 Abdou, Mary
NPI: 1689805939 LIC: 5802
# 5695 Anwar, Lubna
NPI: 1326209586 LIC: 5695
# 31436 Browne, Morgan
NPI: 1316316706 LIC: 31436
# S6-164 Cao, Michael
NPI: 1679020622 LIC: S6-164
# 6824 Culpepper, Marah
NPI: 1366992232 LIC: 6824
# 32232 Dao, Alexander
NPI: 1881148344 LIC: 32232
# 32909 Dao, Minhquan
NPI: 1477082717 LIC: 32909
# 6962 Davidowitz, Rachelle
NPI: 1629594940 LIC: 6962
# S6-118 Ezeanolue, Bibiana
NPI: 1356570998 LIC: S6-118
# 6328 Farokh, Samira
NPI: 1497091367 LIC: 6328
# 51777 Fellars, David
NPI: 1659555076 LIC: 51777
# 3732 Fu, Suzan
NPI: 1144238049 LIC: 3732
# 6063 Guideng, Romulo
NPI: 1174824148 LIC: 6063
# 6530 Han, Irene
NPI: 1639569064 LIC: 6530
# 7124NV Hess, Trevor
NPI: 1831507482 LIC: 7124NV
# S6-165 Hon, Larry
NPI: 1114378866 LIC: S6-165
# 5814 Huynh, James
NPI: 1144452996 LIC: 5814
# 5477 Khairah, Gurpreet
NPI: 1659599280 LIC: 5477
# 6942 Koscinski, Matt
NPI: 1093242232 LIC: 6942
# 5038 Landron, Joan
NPI: 1003892126 LIC: 5038
# S6-108 Manuel, Renalie
NPI: 1902952070 LIC: S6-108
# 3716 Mcintosh, Vivi
NPI: 1124238662 LIC: 3716
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# 25566 Nghiem, Audrey
NPI: 1700190790 LIC: 25566
# 4886 Nguyen, Man
NPI: 1760562557 LIC: 4886
# 7133 Nielson, France
NPI: 1083924971 LIC: 7133
# 5713 Patel, Sarika
NPI: 1346406808 LIC: 5713
# D07110 Peterson, Steven
NPI: 1477600666 LIC: D07110
# 6931 Petrie, Natasha
NPI: 1255795928 LIC: 6931
# 5483 Phan, Dawna
NPI: 1417086661 LIC: 5483
# 4415 Porter, Stansby
NPI: 1851425482 LIC: 4415
# 101448 Pour, Hamid
NPI: 1174043764 LIC: 101448
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
# 7107NV Rezapour, Noura
NPI: 1194205625 LIC: 7107NV
# 7132 Sanikop-Kori, Priyanka
NPI: 1780155820 LIC: 7132
# 6697 Saparam, Nischal
NPI: 1689838005 LIC: 6697
# 7109 Shah, Rahi
NPI: 1053897660 LIC: 7109
# 6894 Shahrokh, Pouyan
NPI: 1013354927 LIC: 6894
# 6949 Sharma, Akanksha
NPI: 1164944278 LIC: 6949
# S6-130 Shroff, Sulabh
NPI: 1811284243 LIC: S6-130
# 4493 Spengler, Sandra
NPI: 1144232976 LIC: 4493
# S5-50C Trinh, Owen
NPI: 1164806907 LIC: S5-50C
# 6776 Vann, Stephen
NPI: 1003035437 LIC: 6776
# 4582 Vernon, Jorge
NPI: 1447420476 LIC: 4582
# 6773 Viravongsa, Christopher
NPI: 1982056818 LIC: 6773
# 5090 Wilson, Jeremy
NPI: 1023186095 LIC: 5090
# 6509 Yap, Kimberly
NPI: 1255615803 LIC: 6509
#007275
Absolute Dental & Orthodontics
169 N. Nellis Blvd
Las Vegas, NV 89110
(702) 384-1010
English, Spanish
M-F 9am - 6pm
# 5802 Abdou, Mary
NPI: 1689805939 LIC: 5802
# 5695 Anwar, Lubna
NPI: 1326209586 LIC: 5695
# 31436 Browne, Morgan
NPI: 1316316706 LIC: 31436
# S6-164 Cao, Michael
NPI: 1679020622 LIC: S6-164
# 6824 Culpepper, Marah
NPI: 1366992232 LIC: 6824
# 32232 Dao, Alexander
NPI: 1881148344 LIC: 32232
# 32909 Dao, Minhquan
NPI: 1477082717 LIC: 32909
# 6962 Davidowitz, Rachelle
NPI: 1629594940 LIC: 6962
# S6-118 Ezeanolue, Bibiana
NPI: 1356570998 LIC: S6-118
# 6328 Farokh, Samira
NPI: 1497091367 LIC: 6328
# 51777 Fellars, David
NPI: 1659555076 LIC: 51777
# 3732 Fu, Suzan
NPI: 1144238049 LIC: 3732
# 6063 Guideng, Romulo
NPI: 1174824148 LIC: 6063
# 6530 Han, Irene
NPI: 1639569064 LIC: 6530
# 7124NV Hess, Trevor
NPI: 1831507482 LIC: 7124NV
# S6-165 Hon, Larry
NPI: 1114378866 LIC: S6-165
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 5 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
# 5814 Huynh, James
NPI: 1144452996 LIC: 5814
# 5477 Khairah, Gurpreet
NPI: 1659599280 LIC: 5477
# 6942 Koscinski, Matt
NPI: 1093242232 LIC: 6942
# 5038 Landron, Joan
NPI: 1003892126 LIC: 5038
# 7077 Mann, Steven
NPI: 1043751779 LIC: 7077
# S6-108 Manuel, Renalie
NPI: 1902952070 LIC: S6-108
# 3716 Mcintosh, Vivi
NPI: 1124238662 LIC: 3716
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# 25566 Nghiem, Audrey
NPI: 1700190790 LIC: 25566
# 4886 Nguyen, Man
NPI: 1760562557 LIC: 4886
# 7133 Nielson, France
NPI: 1083924971 LIC: 7133
# 5713 Patel, Sarika
NPI: 1346406808 LIC: 5713
# D07110 Peterson, Steven
NPI: 1477600666 LIC: D07110
# 6931 Petrie, Natasha
NPI: 1255795928 LIC: 6931
# 5483 Phan, Dawna
NPI: 1417086661 LIC: 5483
# 4415 Porter, Stansby
NPI: 1851425482 LIC: 4415
# 101448 Pour, Hamid
NPI: 1174043764 LIC: 101448
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
# 7107NV Rezapour, Noura
NPI: 1194205625 LIC: 7107NV
# 7132 Sanikop-Kori, Priyanka
NPI: 1780155820 LIC: 7132
# 6697 Saparam, Nischal
NPI: 1689838005 LIC: 6697
# 7109 Shah, Rahi
NPI: 1053897660 LIC: 7109
# 6894 Shahrokh, Pouyan
NPI: 1013354927 LIC: 6894
# 6949 Sharma, Akanksha
NPI: 1164944278 LIC: 6949
# S6-130 Shroff, Sulabh
NPI: 1811284243 LIC: S6-130
# 4493 Spengler, Sandra
NPI: 1144232976 LIC: 4493
# S5-50C Trinh, Owen
NPI: 1164806907 LIC: S5-50C
# 6776 Vann, Stephen
NPI: 1003035437 LIC: 6776
# 4582 Vernon, Jorge
NPI: 1447420476 LIC: 4582
# 6773 Viravongsa, Christopher
NPI: 1982056818 LIC: 6773
# 5090 Wilson, Jeremy
NPI: 1023186095 LIC: 5090
# 6509 Yap, Kimberly
NPI: 1255615803 LIC: 6509
#007280
Absolute Dental & Orthodontics
6110 W. Lake Mead Blvd Ste 150
Las Vegas, NV 89108
(702) 565-4040
English, Spanish
M 9am - 6pm, T 10am - 7pm
W-F 9am-6pm
S 9am - 3pm
# 5802 Abdou, Mary
NPI: 1689805939 LIC: 5802
# 5695 Anwar, Lubna
NPI: 1326209586 LIC: 5695
# 31436 Browne, Morgan
NPI: 1316316706 LIC: 31436
# S6-164 Cao, Michael
NPI: 1679020622 LIC: S6-164
# 6824 Culpepper, Marah
NPI: 1366992232 LIC: 6824
# 32232 Dao, Alexander
NPI: 1881148344 LIC: 32232
# 32909 Dao, Minhquan
NPI: 1477082717 LIC: 32909
# 6962 Davidowitz, Rachelle
NPI: 1629594940 LIC: 6962
# S6-118 Ezeanolue, Bibiana
NPI: 1356570998 LIC: S6-118
# 6328 Farokh, Samira
NPI: 1497091367 LIC: 6328
# 51777 Fellars, David
NPI: 1659555076 LIC: 51777
# 3732 Fu, Suzan
NPI: 1144238049 LIC: 3732
# 6063 Guideng, Romulo
NPI: 1174824148 LIC: 6063
# 6530 Han, Irene
NPI: 1639569064 LIC: 6530
# 7124NV Hess, Trevor
NPI: 1831507482 LIC: 7124NV
# S6-165 Hon, Larry
NPI: 1114378866 LIC: S6-165
# 5814 Huynh, James
NPI: 1144452996 LIC: 5814
# 5477 Khairah, Gurpreet
NPI: 1659599280 LIC: 5477
# 6942 Koscinski, Matt
NPI: 1093242232 LIC: 6942
# 5038 Landron, Joan
NPI: 1003892126 LIC: 5038
# S6-108 Manuel, Renalie
NPI: 1902952070 LIC: S6-108
# 3716 Mcintosh, Vivi
NPI: 1124238662 LIC: 3716
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# 25566 Nghiem, Audrey
NPI: 1700190790 LIC: 25566
# 4886 Nguyen, Man
NPI: 1760562557 LIC: 4886
# 7133 Nielson, France
NPI: 1083924971 LIC: 7133
# 5713 Patel, Sarika
NPI: 1346406808 LIC: 5713
# D07110 Peterson, Steven
NPI: 1477600666 LIC: D07110
# 6931 Petrie, Natasha
NPI: 1255795928 LIC: 6931
# 5483 Phan, Dawna
NPI: 1417086661 LIC: 5483
# 4415 Porter, Stansby
NPI: 1851425482 LIC: 4415
# 101448 Pour, Hamid
NPI: 1174043764 LIC: 101448
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
# 7107NV Rezapour, Noura
NPI: 1194205625 LIC: 7107NV
# 7132 Sanikop-Kori, Priyanka
NPI: 1780155820 LIC: 7132
# 6697 Saparam, Nischal
NPI: 1689838005 LIC: 6697
# 7109 Shah, Rahi
NPI: 1053897660 LIC: 7109
# 6894 Shahrokh, Pouyan
NPI: 1013354927 LIC: 6894
# 6949 Sharma, Akanksha
NPI: 1164944278 LIC: 6949
# S6-130 Shroff, Sulabh
NPI: 1811284243 LIC: S6-130
# 4493 Spengler, Sandra
NPI: 1144232976 LIC: 4493
# S5-50C Trinh, Owen
NPI: 1164806907 LIC: S5-50C
# 6776 Vann, Stephen
NPI: 1003035437 LIC: 6776
# 4582 Vernon, Jorge
NPI: 1447420476 LIC: 4582
# 6773 Viravongsa, Christopher
NPI: 1982056818 LIC: 6773
# 5090 Wilson, Jeremy
NPI: 1023186095 LIC: 5090
# 6509 Yap, Kimberly
NPI: 1255615803 LIC: 6509
#007297
Absolute Dental & Orthodontics
3945 S. Maryland Pkwy Ste A
Las Vegas, NV 89119
(702) 735-3838
English, Spanish, Tagalog, Vietnamese
M-F 9am - 6pm
# 5802 Abdou, Mary
NPI: 1689805939 LIC: 5802
# 5695 Anwar, Lubna
NPI: 1326209586 LIC: 5695
# 31436 Browne, Morgan
NPI: 1316316706 LIC: 31436
# S6-164 Cao, Michael
NPI: 1679020622 LIC: S6-164
# 32232 Dao, Alexander
NPI: 1881148344 LIC: 32232
# 32909 Dao, Minhquan
NPI: 1477082717 LIC: 32909
# 6962 Davidowitz, Rachelle
NPI: 1629594940 LIC: 6962
# 6328 Farokh, Samira
NPI: 1497091367 LIC: 6328
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 6 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
# 51777 Fellars, David
NPI: 1659555076 LIC: 51777
# 3732 Fu, Suzan
NPI: 1144238049 LIC: 3732
# 6063 Guideng, Romulo
NPI: 1174824148 LIC: 6063
# 7124NV Hess, Trevor
NPI: 1831507482 LIC: 7124NV
# S6-165 Hon, Larry
NPI: 1114378866 LIC: S6-165
# 5814 Huynh, James
NPI: 1144452996 LIC: 5814
# 5477 Khairah, Gurpreet
NPI: 1659599280 LIC: 5477
# 5038 Landron, Joan
NPI: 1003892126 LIC: 5038
# S6-108 Manuel, Renalie
NPI: 1902952070 LIC: S6-108
# 3716 Mcintosh, Vivi
NPI: 1124238662 LIC: 3716
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# 25566 Nghiem, Audrey
NPI: 1700190790 LIC: 25566
# 7133 Nielson, France
NPI: 1083924971 LIC: 7133
# 5713 Patel, Sarika
NPI: 1346406808 LIC: 5713
# D07110 Peterson, Steven
NPI: 1477600666 LIC: D07110
# 6931 Petrie, Natasha
NPI: 1255795928 LIC: 6931
# 5483 Phan, Dawna
NPI: 1417086661 LIC: 5483
# 4415 Porter, Stansby
NPI: 1851425482 LIC: 4415
# 101448 Pour, Hamid
NPI: 1174043764 LIC: 101448
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
# 7107NV Rezapour, Noura
NPI: 1194205625 LIC: 7107NV
# 6697 Saparam, Nischal
NPI: 1689838005 LIC: 6697
# 6894 Shahrokh, Pouyan
NPI: 1013354927 LIC: 6894
# 6949 Sharma, Akanksha
NPI: 1164944278 LIC: 6949
# 4493 Spengler, Sandra
NPI: 1144232976 LIC: 4493
# S5-50C Trinh, Owen
NPI: 1164806907 LIC: S5-50C
# 6776 Vann, Stephen
NPI: 1003035437 LIC: 6776
# 6773 Viravongsa, Christopher
NPI: 1982056818 LIC: 6773
# 5090 Wilson, Jeremy
NPI: 1023186095 LIC: 5090
# 6509 Yap, Kimberly
NPI: 1255615803 LIC: 6509
#016634
Absolute Dental & Orthodontics
8370 W. Cheyenne Ave, Ste 103
Las Vegas, NV 89129
(702) 765-4850
English, Spanish
M-F 9am - 6pm
# 5802 Abdou, Mary
NPI: 1689805939 LIC: 5802
# 5695 Anwar, Lubna
NPI: 1326209586 LIC: 5695
# 31436 Browne, Morgan
NPI: 1316316706 LIC: 31436
# S6-164 Cao, Michael
NPI: 1679020622 LIC: S6-164
# 6824 Culpepper, Marah
NPI: 1366992232 LIC: 6824
# 32232 Dao, Alexander
NPI: 1881148344 LIC: 32232
# 32909 Dao, Minhquan
NPI: 1477082717 LIC: 32909
# 6962 Davidowitz, Rachelle
NPI: 1629594940 LIC: 6962
# S6-118 Ezeanolue, Bibiana
NPI: 1356570998 LIC: S6-118
# 6328 Farokh, Samira
NPI: 1497091367 LIC: 6328
# 51777 Fellars, David
NPI: 1659555076 LIC: 51777
# 3732 Fu, Suzan
NPI: 1144238049 LIC: 3732
# 6063 Guideng, Romulo
NPI: 1174824148 LIC: 6063
# 6530 Han, Irene
NPI: 1639569064 LIC: 6530
# 7124NV Hess, Trevor
NPI: 1831507482 LIC: 7124NV
# S6-165 Hon, Larry
NPI: 1114378866 LIC: S6-165
# 5814 Huynh, James
NPI: 1144452996 LIC: 5814
# 5477 Khairah, Gurpreet
NPI: 1659599280 LIC: 5477
# 6942 Koscinski, Matt
NPI: 1093242232 LIC: 6942
# 5038 Landron, Joan
NPI: 1003892126 LIC: 5038
# S6-108 Manuel, Renalie
NPI: 1902952070 LIC: S6-108
# 3716 Mcintosh, Vivi
NPI: 1124238662 LIC: 3716
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# 25566 Nghiem, Audrey
NPI: 1700190790 LIC: 25566
# 4886 Nguyen, Man
NPI: 1760562557 LIC: 4886
# 7133 Nielson, France
NPI: 1083924971 LIC: 7133
# 5713 Patel, Sarika
NPI: 1346406808 LIC: 5713
# D07110 Peterson, Steven
NPI: 1477600666 LIC: D07110
# 6931 Petrie, Natasha
NPI: 1255795928 LIC: 6931
# 5483 Phan, Dawna
NPI: 1417086661 LIC: 5483
# 4415 Porter, Stansby
NPI: 1851425482 LIC: 4415
# 101448 Pour, Hamid
NPI: 1174043764 LIC: 101448
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
# 7107NV Rezapour, Noura
NPI: 1194205625 LIC: 7107NV
# 7132 Sanikop-Kori, Priyanka
NPI: 1780155820 LIC: 7132
# 6697 Saparam, Nischal
NPI: 1689838005 LIC: 6697
# 7109 Shah, Rahi
NPI: 1053897660 LIC: 7109
# 6894 Shahrokh, Pouyan
NPI: 1013354927 LIC: 6894
# 6949 Sharma, Akanksha
NPI: 1164944278 LIC: 6949
# S6-130 Shroff, Sulabh
NPI: 1811284243 LIC: S6-130
# 4493 Spengler, Sandra
NPI: 1144232976 LIC: 4493
# S5-50C Trinh, Owen
NPI: 1164806907 LIC: S5-50C
# 6776 Vann, Stephen
NPI: 1003035437 LIC: 6776
# 4582 Vernon, Jorge
NPI: 1447420476 LIC: 4582
# 6773 Viravongsa, Christopher
NPI: 1982056818 LIC: 6773
# 5090 Wilson, Jeremy
NPI: 1023186095 LIC: 5090
# 6509 Yap, Kimberly
NPI: 1255615803 LIC: 6509
#016671
Absolute Dental & Orthodontics
4035 S. Durango Dr Ste 103
Las Vegas, NV 89147
(702) 804-8888
English, Spanish
M-F 9am - 5pm
# 5802 Abdou, Mary
NPI: 1689805939 LIC: 5802
# 5695 Anwar, Lubna
NPI: 1326209586 LIC: 5695
# 31436 Browne, Morgan
NPI: 1316316706 LIC: 31436
# S6-164 Cao, Michael
NPI: 1679020622 LIC: S6-164
# 6824 Culpepper, Marah
NPI: 1366992232 LIC: 6824
# 32232 Dao, Alexander
NPI: 1881148344 LIC: 32232
# 32909 Dao, Minhquan
NPI: 1477082717 LIC: 32909
# 6962 Davidowitz, Rachelle
NPI: 1629594940 LIC: 6962
# S6-118 Ezeanolue, Bibiana
NPI: 1356570998 LIC: S6-118
# 6328 Farokh, Samira
NPI: 1497091367 LIC: 6328
# 51777 Fellars, David
NPI: 1659555076 LIC: 51777
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 7 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
# 3732 Fu, Suzan
NPI: 1144238049 LIC: 3732
# 6063 Guideng, Romulo
NPI: 1174824148 LIC: 6063
# 6530 Han, Irene
NPI: 1639569064 LIC: 6530
# 7124NV Hess, Trevor
NPI: 1831507482 LIC: 7124NV
# S6-165 Hon, Larry
NPI: 1114378866 LIC: S6-165
# 5814 Huynh, James
NPI: 1144452996 LIC: 5814
# 5477 Khairah, Gurpreet
NPI: 1659599280 LIC: 5477
# 6942 Koscinski, Matt
NPI: 1093242232 LIC: 6942
# 5038 Landron, Joan
NPI: 1003892126 LIC: 5038
# S6-108 Manuel, Renalie
NPI: 1902952070 LIC: S6-108
# 3716 Mcintosh, Vivi
NPI: 1124238662 LIC: 3716
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# 25566 Nghiem, Audrey
NPI: 1700190790 LIC: 25566
# 4886 Nguyen, Man
NPI: 1760562557 LIC: 4886
# 7133 Nielson, France
NPI: 1083924971 LIC: 7133
# 5713 Patel, Sarika
NPI: 1346406808 LIC: 5713
# D07110 Peterson, Steven
NPI: 1477600666 LIC: D07110
# 6931 Petrie, Natasha
NPI: 1255795928 LIC: 6931
# 5483 Phan, Dawna
NPI: 1417086661 LIC: 5483
# 4415 Porter, Stansby
NPI: 1851425482 LIC: 4415
# 101448 Pour, Hamid
NPI: 1174043764 LIC: 101448
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
# 7107NV Rezapour, Noura
NPI: 1194205625 LIC: 7107NV
# 7132 Sanikop-Kori, Priyanka
NPI: 1780155820 LIC: 7132
# 6697 Saparam, Nischal
NPI: 1689838005 LIC: 6697
# 7109 Shah, Rahi
NPI: 1053897660 LIC: 7109
# 6894 Shahrokh, Pouyan
NPI: 1013354927 LIC: 6894
# 6949 Sharma, Akanksha
NPI: 1164944278 LIC: 6949
# S6-130 Shroff, Sulabh
NPI: 1811284243 LIC: S6-130
# 4493 Spengler, Sandra
NPI: 1144232976 LIC: 4493
# S5-50C Trinh, Owen
NPI: 1164806907 LIC: S5-50C
# 6776 Vann, Stephen
NPI: 1003035437 LIC: 6776
# 4582 Vernon, Jorge
NPI: 1447420476 LIC: 4582
# 6773 Viravongsa, Christopher
NPI: 1982056818 LIC: 6773
# 5090 Wilson, Jeremy
NPI: 1023186095 LIC: 5090
# 6509 Yap, Kimberly
NPI: 1255615803 LIC: 6509
#016672
Absolute Dental & Orthodontics
4300 Meadows Ln, Ste 1350
Las Vegas, NV 89107
(702) 472-7320
English, Spanish
M-F 9am - 5pm
# 5802 Abdou, Mary
NPI: 1689805939 LIC: 5802
# 5695 Anwar, Lubna
NPI: 1326209586 LIC: 5695
# 31436 Browne, Morgan
NPI: 1316316706 LIC: 31436
# S6-164 Cao, Michael
NPI: 1679020622 LIC: S6-164
# 32232 Dao, Alexander
NPI: 1881148344 LIC: 32232
# 32909 Dao, Minhquan
NPI: 1477082717 LIC: 32909
# 6962 Davidowitz, Rachelle
NPI: 1629594940 LIC: 6962
# 6328 Farokh, Samira
NPI: 1497091367 LIC: 6328
# 51777 Fellars, David
NPI: 1659555076 LIC: 51777
# 6063 Guideng, Romulo
NPI: 1174824148 LIC: 6063
# 7124NV Hess, Trevor
NPI: 1831507482 LIC: 7124NV
# S6-165 Hon, Larry
NPI: 1114378866 LIC: S6-165
# 5814 Huynh, James
NPI: 1144452996 LIC: 5814
# 5477 Khairah, Gurpreet
NPI: 1659599280 LIC: 5477
# 5038 Landron, Joan
NPI: 1003892126 LIC: 5038
# S6-108 Manuel, Renalie
NPI: 1902952070 LIC: S6-108
# 3716 Mcintosh, Vivi
NPI: 1124238662 LIC: 3716
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# 25566 Nghiem, Audrey
NPI: 1700190790 LIC: 25566
# 7133 Nielson, France
NPI: 1083924971 LIC: 7133
# 5713 Patel, Sarika
NPI: 1346406808 LIC: 5713
# D07110 Peterson, Steven
NPI: 1477600666 LIC: D07110
# 6931 Petrie, Natasha
NPI: 1255795928 LIC: 6931
# 5483 Phan, Dawna
NPI: 1417086661 LIC: 5483
# 4415 Porter, Stansby
NPI: 1851425482 LIC: 4415
# 101448 Pour, Hamid
NPI: 1174043764 LIC: 101448
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
# 7107NV Rezapour, Noura
NPI: 1194205625 LIC: 7107NV
# 6697 Saparam, Nischal
NPI: 1689838005 LIC: 6697
# 6894 Shahrokh, Pouyan
NPI: 1013354927 LIC: 6894
# 6949 Sharma, Akanksha
NPI: 1164944278 LIC: 6949
# 4493 Spengler, Sandra
NPI: 1144232976 LIC: 4493
# S5-50C Trinh, Owen
NPI: 1164806907 LIC: S5-50C
# 6776 Vann, Stephen
NPI: 1003035437 LIC: 6776
# 6773 Viravongsa, Christopher
NPI: 1982056818 LIC: 6773
# 5090 Wilson, Jeremy
NPI: 1023186095 LIC: 5090
# 6509 Yap, Kimberly
NPI: 1255615803 LIC: 6509
#016673
Absolute Dental & Orthodontics
4720 Blue Diamond Rd, Ste 100
Las Vegas, NV 89139
(702) 855-0050
English, Spanish
T 9am - 6pm
W-F 9am-6pm
# 5802 Abdou, Mary
NPI: 1689805939 LIC: 5802
# 5695 Anwar, Lubna
NPI: 1326209586 LIC: 5695
# 31436 Browne, Morgan
NPI: 1316316706 LIC: 31436
# S6-164 Cao, Michael
NPI: 1679020622 LIC: S6-164
# 32232 Dao, Alexander
NPI: 1881148344 LIC: 32232
# 32909 Dao, Minhquan
NPI: 1477082717 LIC: 32909
# 6962 Davidowitz, Rachelle
NPI: 1629594940 LIC: 6962
# 6328 Farokh, Samira
NPI: 1497091367 LIC: 6328
# 51777 Fellars, David
NPI: 1659555076 LIC: 51777
# 6063 Guideng, Romulo
NPI: 1174824148 LIC: 6063
# 7124NV Hess, Trevor
NPI: 1831507482 LIC: 7124NV
# S6-165 Hon, Larry
NPI: 1114378866 LIC: S6-165
# 5814 Huynh, James
NPI: 1144452996 LIC: 5814
# 5477 Khairah, Gurpreet
NPI: 1659599280 LIC: 5477
# 5038 Landron, Joan
NPI: 1003892126 LIC: 5038
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 8 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
# S6-108 Manuel, Renalie
NPI: 1902952070 LIC: S6-108
# 3716 Mcintosh, Vivi
NPI: 1124238662 LIC: 3716
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# 25566 Nghiem, Audrey
NPI: 1700190790 LIC: 25566
# 7133 Nielson, France
NPI: 1083924971 LIC: 7133
# 5713 Patel, Sarika
NPI: 1346406808 LIC: 5713
# D07110 Peterson, Steven
NPI: 1477600666 LIC: D07110
# 6931 Petrie, Natasha
NPI: 1255795928 LIC: 6931
# 5483 Phan, Dawna
NPI: 1417086661 LIC: 5483
# 4415 Porter, Stansby
NPI: 1851425482 LIC: 4415
# 101448 Pour, Hamid
NPI: 1174043764 LIC: 101448
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
# 7107NV Rezapour, Noura
NPI: 1194205625 LIC: 7107NV
# 6697 Saparam, Nischal
NPI: 1689838005 LIC: 6697
# 6894 Shahrokh, Pouyan
NPI: 1013354927 LIC: 6894
# 6949 Sharma, Akanksha
NPI: 1164944278 LIC: 6949
# 4493 Spengler, Sandra
NPI: 1144232976 LIC: 4493
# S5-50C Trinh, Owen
NPI: 1164806907 LIC: S5-50C
# 6776 Vann, Stephen
NPI: 1003035437 LIC: 6776
# 6773 Viravongsa, Christopher
NPI: 1982056818 LIC: 6773
# 5090 Wilson, Jeremy
NPI: 1023186095 LIC: 5090
# 6509 Yap, Kimberly
NPI: 1255615803 LIC: 6509
#016674
Absolute Dental & Orthodontics
7320 S. Rainbow Blvd, Ste 103
Las Vegas, NV 89139
(702) 450-0070
English, Spanish
M-F 8am - 4pm
# 5802 Abdou, Mary
NPI: 1689805939 LIC: 5802
# 5695 Anwar, Lubna
NPI: 1326209586 LIC: 5695
# 31436 Browne, Morgan
NPI: 1316316706 LIC: 31436
# S6-164 Cao, Michael
NPI: 1679020622 LIC: S6-164
# 6824 Culpepper, Marah
NPI: 1366992232 LIC: 6824
# 32232 Dao, Alexander
NPI: 1881148344 LIC: 32232
# 32909 Dao, Minhquan
NPI: 1477082717 LIC: 32909
# 6962 Davidowitz, Rachelle
NPI: 1629594940 LIC: 6962
# S6-118 Ezeanolue, Bibiana
NPI: 1356570998 LIC: S6-118
# 6328 Farokh, Samira
NPI: 1497091367 LIC: 6328
# 51777 Fellars, David
NPI: 1659555076 LIC: 51777
# 3732 Fu, Suzan
NPI: 1144238049 LIC: 3732
# 6063 Guideng, Romulo
NPI: 1174824148 LIC: 6063
# 6530 Han, Irene
NPI: 1639569064 LIC: 6530
# 7124NV Hess, Trevor
NPI: 1831507482 LIC: 7124NV
# S6-165 Hon, Larry
NPI: 1114378866 LIC: S6-165
# 5814 Huynh, James
NPI: 1144452996 LIC: 5814
# 5477 Khairah, Gurpreet
NPI: 1659599280 LIC: 5477
# 6942 Koscinski, Matt
NPI: 1093242232 LIC: 6942
# 5038 Landron, Joan
NPI: 1003892126 LIC: 5038
# S6-108 Manuel, Renalie
NPI: 1902952070 LIC: S6-108
# 3716 Mcintosh, Vivi
NPI: 1124238662 LIC: 3716
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# 25566 Nghiem, Audrey
NPI: 1700190790 LIC: 25566
# 4886 Nguyen, Man
NPI: 1760562557 LIC: 4886
# 7133 Nielson, France
NPI: 1083924971 LIC: 7133
# 5713 Patel, Sarika
NPI: 1346406808 LIC: 5713
# D07110 Peterson, Steven
NPI: 1477600666 LIC: D07110
# 6931 Petrie, Natasha
NPI: 1255795928 LIC: 6931
# 5483 Phan, Dawna
NPI: 1417086661 LIC: 5483
# 4415 Porter, Stansby
NPI: 1851425482 LIC: 4415
# 101448 Pour, Hamid
NPI: 1174043764 LIC: 101448
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
# 7107NV Rezapour, Noura
NPI: 1194205625 LIC: 7107NV
# 7132 Sanikop-Kori, Priyanka
NPI: 1780155820 LIC: 7132
# 6697 Saparam, Nischal
NPI: 1689838005 LIC: 6697
# 7109 Shah, Rahi
NPI: 1053897660 LIC: 7109
# 6894 Shahrokh, Pouyan
NPI: 1013354927 LIC: 6894
# 6949 Sharma, Akanksha
NPI: 1164944278 LIC: 6949
# S6-130 Shroff, Sulabh
NPI: 1811284243 LIC: S6-130
# 4493 Spengler, Sandra
NPI: 1144232976 LIC: 4493
# S5-50C Trinh, Owen
NPI: 1164806907 LIC: S5-50C
# 6776 Vann, Stephen
NPI: 1003035437 LIC: 6776
# 4582 Vernon, Jorge
NPI: 1447420476 LIC: 4582
# 6773 Viravongsa, Christopher
NPI: 1982056818 LIC: 6773
# 5090 Wilson, Jeremy
NPI: 1023186095 LIC: 5090
# 6509 Yap, Kimberly
NPI: 1255615803 LIC: 6509
#016675
Absolute Dental & Orthodontics
8380 W. Cheyenne Ave Ste 102
Las Vegas, NV 89129
(702) 388-8989
M-F 8am - 5pm
# 5802 Abdou, Mary
NPI: 1689805939 LIC: 5802
# 5695 Anwar, Lubna
NPI: 1326209586 LIC: 5695
# 31436 Browne, Morgan
NPI: 1316316706 LIC: 31436
# S6-164 Cao, Michael
NPI: 1679020622 LIC: S6-164
# 6824 Culpepper, Marah
NPI: 1366992232 LIC: 6824
# 32232 Dao, Alexander
NPI: 1881148344 LIC: 32232
# 32909 Dao, Minhquan
NPI: 1477082717 LIC: 32909
# 6962 Davidowitz, Rachelle
NPI: 1629594940 LIC: 6962
# S6-118 Ezeanolue, Bibiana
NPI: 1356570998 LIC: S6-118
# 6328 Farokh, Samira
NPI: 1497091367 LIC: 6328
# 51777 Fellars, David
NPI: 1659555076 LIC: 51777
# 3732 Fu, Suzan
NPI: 1144238049 LIC: 3732
# 6063 Guideng, Romulo
NPI: 1174824148 LIC: 6063
# 6530 Han, Irene
NPI: 1639569064 LIC: 6530
# 7124NV Hess, Trevor
NPI: 1831507482 LIC: 7124NV
# S6-165 Hon, Larry
NPI: 1114378866 LIC: S6-165
# 5814 Huynh, James
NPI: 1144452996 LIC: 5814
# 5477 Khairah, Gurpreet
NPI: 1659599280 LIC: 5477
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 9 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
# 6942 Koscinski, Matt
NPI: 1093242232 LIC: 6942
# 5038 Landron, Joan
NPI: 1003892126 LIC: 5038
# S6-108 Manuel, Renalie
NPI: 1902952070 LIC: S6-108
# 3716 Mcintosh, Vivi
NPI: 1124238662 LIC: 3716
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# 25566 Nghiem, Audrey
NPI: 1700190790 LIC: 25566
# 4886 Nguyen, Man
NPI: 1760562557 LIC: 4886
# 7133 Nielson, France
NPI: 1083924971 LIC: 7133
# 5713 Patel, Sarika
NPI: 1346406808 LIC: 5713
# D07110 Peterson, Steven
NPI: 1477600666 LIC: D07110
# 6931 Petrie, Natasha
NPI: 1255795928 LIC: 6931
# 5483 Phan, Dawna
NPI: 1417086661 LIC: 5483
# 4415 Porter, Stansby
NPI: 1851425482 LIC: 4415
# 101448 Pour, Hamid
NPI: 1174043764 LIC: 101448
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
# 7107NV Rezapour, Noura
NPI: 1194205625 LIC: 7107NV
# 7132 Sanikop-Kori, Priyanka
NPI: 1780155820 LIC: 7132
# 6697 Saparam, Nischal
NPI: 1689838005 LIC: 6697
# 7109 Shah, Rahi
NPI: 1053897660 LIC: 7109
# 6894 Shahrokh, Pouyan
NPI: 1013354927 LIC: 6894
# 6949 Sharma, Akanksha
NPI: 1164944278 LIC: 6949
# S6-130 Shroff, Sulabh
NPI: 1811284243 LIC: S6-130
# 4493 Spengler, Sandra
NPI: 1144232976 LIC: 4493
# S5-50C Trinh, Owen
NPI: 1164806907 LIC: S5-50C
# 6776 Vann, Stephen
NPI: 1003035437 LIC: 6776
# 4582 Vernon, Jorge
NPI: 1447420476 LIC: 4582
# 6773 Viravongsa, Christopher
NPI: 1982056818 LIC: 6773
# 5090 Wilson, Jeremy
NPI: 1023186095 LIC: 5090
# 6509 Yap, Kimberly
NPI: 1255615803 LIC: 6509
#016676
Absolute Dental & Orthodontics
8430 W. Farm Rd Ste 120
Las Vegas, NV 89131
(702) 732-1010
English, Spanish
M-F 9am - 6pm
# 5802 Abdou, Mary
NPI: 1689805939 LIC: 5802
# 5695 Anwar, Lubna
NPI: 1326209586 LIC: 5695
# 31436 Browne, Morgan
NPI: 1316316706 LIC: 31436
# S6-164 Cao, Michael
NPI: 1679020622 LIC: S6-164
# 32232 Dao, Alexander
NPI: 1881148344 LIC: 32232
# 32909 Dao, Minhquan
NPI: 1477082717 LIC: 32909
# 6962 Davidowitz, Rachelle
NPI: 1629594940 LIC: 6962
# 6328 Farokh, Samira
NPI: 1497091367 LIC: 6328
# 51777 Fellars, David
NPI: 1659555076 LIC: 51777
# 6063 Guideng, Romulo
NPI: 1174824148 LIC: 6063
# 7124NV Hess, Trevor
NPI: 1831507482 LIC: 7124NV
# S6-165 Hon, Larry
NPI: 1114378866 LIC: S6-165
# 5814 Huynh, James
NPI: 1144452996 LIC: 5814
# 5477 Khairah, Gurpreet
NPI: 1659599280 LIC: 5477
# 5038 Landron, Joan
NPI: 1003892126 LIC: 5038
# S6-108 Manuel, Renalie
NPI: 1902952070 LIC: S6-108
# 3716 Mcintosh, Vivi
NPI: 1124238662 LIC: 3716
# 25566 Nghiem, Audrey
NPI: 1700190790 LIC: 25566
# 7133 Nielson, France
NPI: 1083924971 LIC: 7133
# 5713 Patel, Sarika
NPI: 1346406808 LIC: 5713
# D07110 Peterson, Steven
NPI: 1477600666 LIC: D07110
# 6931 Petrie, Natasha
NPI: 1255795928 LIC: 6931
# 5483 Phan, Dawna
NPI: 1417086661 LIC: 5483
# 4415 Porter, Stansby
NPI: 1851425482 LIC: 4415
# 101448 Pour, Hamid
NPI: 1174043764 LIC: 101448
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
# 7107NV Rezapour, Noura
NPI: 1194205625 LIC: 7107NV
# 6697 Saparam, Nischal
NPI: 1689838005 LIC: 6697
# 6894 Shahrokh, Pouyan
NPI: 1013354927 LIC: 6894
# 6949 Sharma, Akanksha
NPI: 1164944278 LIC: 6949
# 4493 Spengler, Sandra
NPI: 1144232976 LIC: 4493
# S5-50C Trinh, Owen
NPI: 1164806907 LIC: S5-50C
# 6776 Vann, Stephen
NPI: 1003035437 LIC: 6776
# 6773 Viravongsa, Christopher
NPI: 1982056818 LIC: 6773
# 5090 Wilson, Jeremy
NPI: 1023186095 LIC: 5090
# 6509 Yap, Kimberly
NPI: 1255615803 LIC: 6509
#016677
Absolute Dental & Orthodontics
945 S. Rainbow Blvd
Las Vegas, NV 89145
(702) 331-8585
English, Spanish
M 9am - 6pm, T 8am - 5pm
W 9am-6am, Th 9am-6pm, F 9am-3pm
# 5802 Abdou, Mary
NPI: 1689805939 LIC: 5802
# 5695 Anwar, Lubna
NPI: 1326209586 LIC: 5695
# 31436 Browne, Morgan
NPI: 1316316706 LIC: 31436
# S6-164 Cao, Michael
NPI: 1679020622 LIC: S6-164
# 32232 Dao, Alexander
NPI: 1881148344 LIC: 32232
# 32909 Dao, Minhquan
NPI: 1477082717 LIC: 32909
# 6962 Davidowitz, Rachelle
NPI: 1629594940 LIC: 6962
# 6328 Farokh, Samira
NPI: 1497091367 LIC: 6328
# 51777 Fellars, David
NPI: 1659555076 LIC: 51777
# 6063 Guideng, Romulo
NPI: 1174824148 LIC: 6063
# 7124NV Hess, Trevor
NPI: 1831507482 LIC: 7124NV
# S6-165 Hon, Larry
NPI: 1114378866 LIC: S6-165
# 5814 Huynh, James
NPI: 1144452996 LIC: 5814
# 5477 Khairah, Gurpreet
NPI: 1659599280 LIC: 5477
# 5038 Landron, Joan
NPI: 1003892126 LIC: 5038
# S6-108 Manuel, Renalie
NPI: 1902952070 LIC: S6-108
# 3716 Mcintosh, Vivi
NPI: 1124238662 LIC: 3716
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# 25566 Nghiem, Audrey
NPI: 1700190790 LIC: 25566
# 7133 Nielson, France
NPI: 1083924971 LIC: 7133
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 10 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
# 5713 Patel, Sarika
NPI: 1346406808 LIC: 5713
# D07110 Peterson, Steven
NPI: 1477600666 LIC: D07110
# 6931 Petrie, Natasha
NPI: 1255795928 LIC: 6931
# 5483 Phan, Dawna
NPI: 1417086661 LIC: 5483
# 4415 Porter, Stansby
NPI: 1851425482 LIC: 4415
# 101448 Pour, Hamid
NPI: 1174043764 LIC: 101448
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
# 7107NV Rezapour, Noura
NPI: 1194205625 LIC: 7107NV
# 6697 Saparam, Nischal
NPI: 1689838005 LIC: 6697
# 6894 Shahrokh, Pouyan
NPI: 1013354927 LIC: 6894
# 6949 Sharma, Akanksha
NPI: 1164944278 LIC: 6949
# 4493 Spengler, Sandra
NPI: 1144232976 LIC: 4493
# S5-50C Trinh, Owen
NPI: 1164806907 LIC: S5-50C
# 6776 Vann, Stephen
NPI: 1003035437 LIC: 6776
# 6773 Viravongsa, Christopher
NPI: 1982056818 LIC: 6773
# 5090 Wilson, Jeremy
NPI: 1023186095 LIC: 5090
# 6509 Yap, Kimberly
NPI: 1255615803 LIC: 6509
#016680
Absolute Dental & Orthodontics
1860 E. Charleston Blvd
Las Vegas, NV 89104
(702) 365-6800
English, Spanish
M-F 9am - 6pm
# 5802 Abdou, Mary
NPI: 1689805939 LIC: 5802
# 5695 Anwar, Lubna
NPI: 1326209586 LIC: 5695
# 31436 Browne, Morgan
NPI: 1316316706 LIC: 31436
# S6-164 Cao, Michael
NPI: 1679020622 LIC: S6-164
# 32232 Dao, Alexander
NPI: 1881148344 LIC: 32232
# 32909 Dao, Minhquan
NPI: 1477082717 LIC: 32909
# 6962 Davidowitz, Rachelle
NPI: 1629594940 LIC: 6962
# 6328 Farokh, Samira
NPI: 1497091367 LIC: 6328
# 51777 Fellars, David
NPI: 1659555076 LIC: 51777
# 6063 Guideng, Romulo
NPI: 1174824148 LIC: 6063
# 7124NV Hess, Trevor
NPI: 1831507482 LIC: 7124NV
# S6-165 Hon, Larry
NPI: 1114378866 LIC: S6-165
# 5814 Huynh, James
NPI: 1144452996 LIC: 5814
# 5477 Khairah, Gurpreet
NPI: 1659599280 LIC: 5477
# 5038 Landron, Joan
NPI: 1003892126 LIC: 5038
# S6-108 Manuel, Renalie
NPI: 1902952070 LIC: S6-108
# 3716 Mcintosh, Vivi
NPI: 1124238662 LIC: 3716
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# 25566 Nghiem, Audrey
NPI: 1700190790 LIC: 25566
# 7133 Nielson, France
NPI: 1083924971 LIC: 7133
# 5713 Patel, Sarika
NPI: 1346406808 LIC: 5713
# D07110 Peterson, Steven
NPI: 1477600666 LIC: D07110
# 6931 Petrie, Natasha
NPI: 1255795928 LIC: 6931
# 5483 Phan, Dawna
NPI: 1417086661 LIC: 5483
# 4415 Porter, Stansby
NPI: 1851425482 LIC: 4415
# 101448 Pour, Hamid
NPI: 1174043764 LIC: 101448
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
# 7107NV Rezapour, Noura
NPI: 1194205625 LIC: 7107NV
# 6697 Saparam, Nischal
NPI: 1689838005 LIC: 6697
# 6894 Shahrokh, Pouyan
NPI: 1013354927 LIC: 6894
# 6949 Sharma, Akanksha
NPI: 1164944278 LIC: 6949
# 4493 Spengler, Sandra
NPI: 1144232976 LIC: 4493
# S5-50C Trinh, Owen
NPI: 1164806907 LIC: S5-50C
# 6776 Vann, Stephen
NPI: 1003035437 LIC: 6776
# 6773 Viravongsa, Christopher
NPI: 1982056818 LIC: 6773
# 5090 Wilson, Jeremy
NPI: 1023186095 LIC: 5090
# 6509 Yap, Kimberly
NPI: 1255615803 LIC: 6509
#017182
Absolute Dental & Orthodontics
860 S. Rancho Dr, Ste 4
Las Vegas, NV 89106
(702) 870-3811
English, Spanish
T 9am - 5pm
W-F 9am-5pm
S 9am - 5pm
# 5802 Abdou, Mary
NPI: 1689805939 LIC: 5802
# 5695 Anwar, Lubna
NPI: 1326209586 LIC: 5695
# 31436 Browne, Morgan
NPI: 1316316706 LIC: 31436
# S6-164 Cao, Michael
NPI: 1679020622 LIC: S6-164
# 32232 Dao, Alexander
NPI: 1881148344 LIC: 32232
# 32909 Dao, Minhquan
NPI: 1477082717 LIC: 32909
# 6962 Davidowitz, Rachelle
NPI: 1629594940 LIC: 6962
# S6-118 Ezeanolue, Bibiana
NPI: 1356570998 LIC: S6-118
# 6328 Farokh, Samira
NPI: 1497091367 LIC: 6328
# 51777 Fellars, David
NPI: 1659555076 LIC: 51777
# 3732 Fu, Suzan
NPI: 1144238049 LIC: 3732
# 6063 Guideng, Romulo
NPI: 1174824148 LIC: 6063
# 6530 Han, Irene
NPI: 1639569064 LIC: 6530
# 7124NV Hess, Trevor
NPI: 1831507482 LIC: 7124NV
# S6-165 Hon, Larry
NPI: 1114378866 LIC: S6-165
# 6946 Hua, Anthony
NPI: 1558883512 LIC: 6946
# 5814 Huynh, James
NPI: 1144452996 LIC: 5814
# 5477 Khairah, Gurpreet
NPI: 1659599280 LIC: 5477
# 6942 Koscinski, Matt
NPI: 1093242232 LIC: 6942
# 5038 Landron, Joan
NPI: 1003892126 LIC: 5038
# S6-108 Manuel, Renalie
NPI: 1902952070 LIC: S6-108
# 3716 Mcintosh, Vivi
NPI: 1124238662 LIC: 3716
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# 25566 Nghiem, Audrey
NPI: 1700190790 LIC: 25566
# 4886 Nguyen, Man
NPI: 1760562557 LIC: 4886
# 7133 Nielson, France
NPI: 1083924971 LIC: 7133
# 5713 Patel, Sarika
NPI: 1346406808 LIC: 5713
# D07110 Peterson, Steven
NPI: 1477600666 LIC: D07110
# 6931 Petrie, Natasha
NPI: 1255795928 LIC: 6931
# 5483 Phan, Dawna
NPI: 1417086661 LIC: 5483
# 4415 Porter, Stansby
NPI: 1851425482 LIC: 4415
# 101448 Pour, Hamid
NPI: 1174043764 LIC: 101448
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 11 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
# 7107NV Rezapour, Noura
NPI: 1194205625 LIC: 7107NV
# 7132 Sanikop-Kori, Priyanka
NPI: 1780155820 LIC: 7132
# 6697 Saparam, Nischal
NPI: 1689838005 LIC: 6697
# 7109 Shah, Rahi
NPI: 1053897660 LIC: 7109
# 6894 Shahrokh, Pouyan
NPI: 1013354927 LIC: 6894
# 6949 Sharma, Akanksha
NPI: 1164944278 LIC: 6949
# S6-130 Shroff, Sulabh
NPI: 1811284243 LIC: S6-130
# 4493 Spengler, Sandra
NPI: 1144232976 LIC: 4493
# S5-50C Trinh, Owen
NPI: 1164806907 LIC: S5-50C
# 6776 Vann, Stephen
NPI: 1003035437 LIC: 6776
# 6773 Viravongsa, Christopher
NPI: 1982056818 LIC: 6773
# 5090 Wilson, Jeremy
NPI: 1023186095 LIC: 5090
# 6509 Yap, Kimberly
NPI: 1255615803 LIC: 6509
#007942
Aces Dental
6127 S. Rainbow Blvd, Ste 100
Las Vegas, NV 89118
(702) 998-2237
English, Spanish, French, Hindi
M 8am - 5pm, T 9am - 5pm
Th-F 9am-5pm
S 9am - 5pm
# 6893 Nguyen, Hong
NPI: 1760837033 LIC: 6893
#016335
Aces Dental
3674 E. Sunset Rd
Las Vegas, NV 89120
(702) 998-2237
English, Spanish, French, Hindi
M-F 9am - 5pm
# 6760 Aquino, Gabrielle
NPI: 1124482682 LIC: 6760
# 5104 Gupta, Manisha
NPI: 1255543328 LIC: 5104
# 6893 Nguyen, Hong
NPI: 1760837033 LIC: 6893
# 6670NV Nou, Cindy
NPI: 1902280654 LIC: 6670NV
# 5053 Sastry, Vilas
NPI: 1104921279 LIC: 5053
#007098
Affordable Dental at Flamingo and
Sandhill
3730 E. Flamingo Rd
Las Vegas, NV 89121
(702) 898-9200
Vietnamese, Spanish
M 9am - 5pm, T 10am - 6pm
Th-F 9am-5pm
S 9am - 3pm
# 6902NV Chi, Hyunseok
NPI: 1124258736 LIC: 6902NV
# 4552 Hang, John
NPI: 1033261185 LIC: 4552
# 6637NV Phui, Andy
NPI: 1811371818 LIC: 6637NV
# 3692 Ting, David
NPI: 1699887919 LIC: 3692
#018787
Aghakhani Dental Corporation Inc
Crystal Dental
1811 S. Rainbow Blvd Ste 101
Las Vegas, NV 89146
(702) 805-4200
English, Farsi, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# 42106 Aghakhani, Arash
NPI: 1851450993 LIC: 42106
# 4652 Mack, John
NPI: 1043400534 LIC: 4652
# 7114 Traeger, Crystal
NPI: 1285110528 LIC: 7114
#012792
All About Beautiful Smiles Dental
8665 W Flamingo Rd Ste 104
Las Vegas, NV 89147
(702) 982-0800
English, Chinese Mandarin, Hindi,
Panjabi, Sindhi, Spanish
M-F 8am - 5pm
# 4640 Phen, Huai
NPI: 1851460539 LIC: 4640
#007059
Allstar Dental
737 N. Nellis Blvd.
Las Vegas, NV 89110
(702) 453-2337
French, Spanish, Tagalog, Vietnamese
M-F 9am - 6pm
# 3505 Tran, Tan*
NPI: 1003977760 LIC: 3505
#014493
Aloha Dental Care
3955 S. Durango Dr, Ste B3
Las Vegas, NV 89147
(702) 242-6777
English, Spanish
M-F 9am - 5pm
# 6252 Gelo Iii, Joseph
NPI: 1922355296 LIC: 6252
#006540
Ambient Dental
6007 S. Rainbow Blvd
Las Vegas, NV 89118
(702) 737-9008
English, Spanish, French, Vietnamese
M-F 9am - 6pm
# 3505 Tran, Tan
NPI: 1003977760 LIC: 3505
#014926
Atlas Dental Group
7460 S. Rainbow Blvd, Ste 100
Las Vegas, NV 89139
(702) 900-7860
English, Spanish, Tagalog
M-F 9am - 6pm
# 6711 Aranas, Jubert
NPI: 1275814865 LIC: 6711
#021897
Bliss Dental LV
6720 N. Hualapai Way, Ste 105
Las Vegas, NV 89149
(702) 850-5252
English, Spanish, Chinese (T),
Tagalog
M-F 9am - 5pm
# 6509 Yap, Kimberly
NPI: 1255615803 LIC: 6509
#016740
Boca Dental & Braces
5642 S. Eastern Ave Ste B
Las Vegas, NV 89119
(702) 456-0005
English, Spanish
M-F 9am - 6pm
# 7136NV Benson, Brett
NPI: 1710012091 LIC: 7136NV
# 6743 Dannels, Wyatt
NPI: 1578997862 LIC: 6743
# 6868 Goodman, Christopher
NPI: 1518174259 LIC: 6868
# 6496 Pritz, Norma
NPI: 1962825448 LIC: 6496
# 7001 Tam, Calvin
NPI: 1316452717 LIC: 7001
# 7008NV Velasco, David
NPI: 1972658524 LIC: 7008NV
# 6997 Yang, Ji
NPI: 1184130858 LIC: 6997
#018786
Boca Dental and Braces
4750 W. Sahara Ave, Ste 11
Las Vegas, NV 89102
(702) 456-0005
English, Korean, Spanish
M-F 9am - 5pm
# 7136NV Benson, Brett*
NPI: 1710012091 LIC: 7136NV
# 6743 Dannels, Wyatt*
NPI: 1578997862 LIC: 6743
# 6868 Goodman, Christopher*
NPI: 1518174259 LIC: 6868
# 6496 Pritz, Norma*
NPI: 1962825448 LIC: 6496
# 7001 Tam, Calvin*
NPI: 1316452717 LIC: 7001
# 7008NV Velasco, David*
NPI: 1972658524 LIC: 7008NV
# 6997 Yang, Ji*
NPI: 1184130858 LIC: 6997
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 12 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
#021610
Boca Dental and Braces
4235 E. Charleston Blvd
Las Vegas, NV 89104
(702) 381-7059
English, Spanish
M-F 9am - 8pm
# 6743 Dannels, Wyatt
NPI: 1578997862 LIC: 6743
# 6496 Pritz, Norma
NPI: 1962825448 LIC: 6496
# 7008NV Velasco, David
NPI: 1972658524 LIC: 7008NV
# 6997 Yang, Ji
NPI: 1184130858 LIC: 6997
#007182
Brighton Dental
5075 E. Bonanza Rd
Las Vegas, NV 89110
(702) 871-8888
Spanish
M-F 9am - 5pm
# 7007NV Bowen, Douglas
NPI: 1114446564 LIC: 7007NV
# 4883 Cappiello, Aida
NPI: 1639217466 LIC: 4883
# 6902NV Chi, Hyunseok
NPI: 1124258736 LIC: 6902NV
# 3046 Chin, Harvey
NPI: 1558538090 LIC: 3046
# 6937 Cho, Alan
NPI: 1710400858 LIC: 6937
# 4274 Chung, David
NPI: 1962505875 LIC: 4274
# 32232 Dao, Alexander
NPI: 1881148344 LIC: 32232
# 6904 Galada, Michael
NPI: 1134559636 LIC: 6904
# 6558 Goshimea, Dawit
NPI: 1821497900 LIC: 6558
# 6891 Ha, Annie
NPI: 1487095279 LIC: 6891
# 4552 Hang, John
NPI: 1033261185 LIC: 4552
# 3072 Justice, Glenn
NPI: 1790716355 LIC: 3072
# 6813 Lee, Charles
NPI: 1306143847 LIC: 6813
# 6821 Lee, Teresa
NPI: 1659825628 LIC: 6821
# 4170 Morris, Steven
NPI: 1891903308 LIC: 4170
# 6841 Nguyen, Jack
NPI: 1700323839 LIC: 6841
# 4751NV Pak, Minyoung
(Jonathan)
NPI: 1679776413 LIC: 4751NV
# 6637NV Phui, Andy
NPI: 1811371818 LIC: 6637NV
# 3063 Ponce, Monica
NPI: 1174598882 LIC: 3063
# 6496 Pritz, Norma
NPI: 1962825448 LIC: 6496
# 6092 Rosales, Jon-Christopher
NPI: 1144503640 LIC: 6092
# 100268 Ruangjumrusvet, Chanon
NPI: 1285083287 LIC: 100268
# 47660 Sayedna, Shahram
NPI: 1497890768 LIC: 47660
# 5737 Tiburcio, Don
NPI: 1962666719 LIC: 5737
# 3692 Ting, David
NPI: 1699887919 LIC: 3692
# 6641 Tran, Mason
NPI: 1679960611 LIC: 6641
#007320
Cavitybusters - Rainbow
6910 S Rainbow Blvd Ste 104
Las Vegas, NV 89118
(702) 362-5437
Vietnamese, Spanish
M 10am - 7pm, T 8am - 5pm
Th-F 8am-5pm
# S6-52 Bui, Quang
NPI: 1043396906 LIC: S6-52
#017374
Celebrate Dental & Braces
5900 W. Cheyenne Ave
Las Vegas, NV 89108
(702) 674-7000
English, Korean, Cantonese,
Japanese, Samoan, Spanish
M-F 8am - 7pm
# 6629 Boyd, Robert
NPI: 1013392539 LIC: 6629
# 6626 Lee, Philip
NPI: 1538540380 LIC: 6626
#021815
Celebrate Dental and Braces
2466 E. Desert Inn, Ste F
Las Vegas, NV 89121
(702) 663-7000
English, Korean, Cantonese,
Japanese, Samoan, Spanish
M-F 8am - 7pm
# 6629 Boyd, Robert
NPI: 1013392539 LIC: 6629
# 6626 Lee, Philip
NPI: 1538540380 LIC: 6626
#017238
Cheyenne Decatur Dental
3226 N. Decatur Blvd
Las Vegas, NV 89130
(702) 648-6800
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# 1007 Justice Jr, Owen
NPI: 1891794442 LIC: 1007
#008305
Children's Dental Group
8430 W. Lake Mead Blvd, Ste 150
Las Vegas, NV 89128
(702) 220-9100
English, Russian, Armenian (T),
Spanish
T 1pm - 5pm
W-Th 1pm-5pm
# 3076 Michaelian, Andre
NPI: 1265578587 LIC: 3076
#017172
Children's Dentistry
6325 E. Russell Rd #100
Las Vegas, NV 89122
(702) 489-0870
English, Spanish
M-F 9am - 5pm
# 4334 Barbin, Francesca
NPI: 1689758252 LIC: 4334
# 6866 Borghei, Sarah
NPI: 1447796636 LIC: 6866
# 6754 Campbell, Amanda
NPI: 1831504612 LIC: 6754
# 5929 Delisle, Steven
NPI: 1639329337 LIC: 5929
# 6752 Delisle, Nicholas
NPI: 1073963385 LIC: 6752
# 6024 Gandotra, Vivek
NPI: 1013054931 LIC: 6024
# 6831 Kim, Eugene
NPI: 1306361845 LIC: 6831
# 5606 Lebroke, Ronald
NPI: 1336310309 LIC: 5606
# 6549 Lee, Steven
NPI: 1538569389 LIC: 6549
# 6830CA Lim, Jason
NPI: 1184980955 LIC: 6830CA
# 6659 Mismas, Rachel
NPI: 1619015831 LIC: 6659
# 6841 Nguyen, Jack
NPI: 1700323839 LIC: 6841
# 6925 Patel, Payal
NPI: 1790149193 LIC: 6925
# 3080 Richens, Bradley
NPI: 1437163078 LIC: 3080
# S6-120 Salar, Behnam
NPI: 1629326400 LIC: S6-120
# 6463 Truong, Vanna
NPI: 1629400130 LIC: 6463
# 7137 Wong, Joel
NPI: 1962987602 LIC: 7137
# 2901022360 Zeitoun, Ali
NPI: 1346761368 LIC: 2901022360
#017173
Children's Dentistry
6415 S. Fort Apache #150
Las Vegas, NV 89148
(702) 710-0801
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
S 9am - 4pm
# 4334 Barbin, Francesca
NPI: 1689758252 LIC: 4334
# 6866 Borghei, Sarah
NPI: 1447796636 LIC: 6866
# 6754 Campbell, Amanda
NPI: 1831504612 LIC: 6754
# 5929 Delisle, Steven
NPI: 1639329337 LIC: 5929
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 13 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
# 6752 Delisle, Nicholas
NPI: 1073963385 LIC: 6752
# 6024 Gandotra, Vivek
NPI: 1013054931 LIC: 6024
# 6831 Kim, Eugene
NPI: 1306361845 LIC: 6831
# 5606 Lebroke, Ronald
NPI: 1336310309 LIC: 5606
# 6549 Lee, Steven
NPI: 1538569389 LIC: 6549
# 6830CA Lim, Jason
NPI: 1184980955 LIC: 6830CA
# 6659 Mismas, Rachel
NPI: 1619015831 LIC: 6659
# 6841 Nguyen, Jack
NPI: 1700323839 LIC: 6841
# 6925 Patel, Payal
NPI: 1790149193 LIC: 6925
# 3080 Richens, Bradley
NPI: 1437163078 LIC: 3080
# S6-120 Salar, Behnam
NPI: 1629326400 LIC: S6-120
# 6463 Truong, Vanna
NPI: 1629400130 LIC: 6463
# 7137 Wong, Joel
NPI: 1962987602 LIC: 7137
# 2901022360 Zeitoun, Ali
NPI: 1346761368 LIC: 2901022360
#016522
Children's Dentistry of Desert Inn
1500 Desert Inn Ave Ste #1
Las Vegas, NV 89169
(702) 707-9597
English, Spanish
M-T 8am-4pm
Th-F 8am-4pm
S 8am - 4pm
# 4334 Barbin, Francesca
NPI: 1689758252 LIC: 4334
# 6866 Borghei, Sarah
NPI: 1447796636 LIC: 6866
# 6754 Campbell, Amanda
NPI: 1831504612 LIC: 6754
# 5929 Delisle, Steven
NPI: 1639329337 LIC: 5929
# 6752 Delisle, Nicholas
NPI: 1073963385 LIC: 6752
# 6024 Gandotra, Vivek
NPI: 1013054931 LIC: 6024
# 6831 Kim, Eugene
NPI: 1306361845 LIC: 6831
# 5606 Lebroke, Ronald
NPI: 1336310309 LIC: 5606
# 6549 Lee, Steven
NPI: 1538569389 LIC: 6549
# 6830CA Lim, Jason
NPI: 1184980955 LIC: 6830CA
# 6659 Mismas, Rachel
NPI: 1619015831 LIC: 6659
# 6841 Nguyen, Jack
NPI: 1700323839 LIC: 6841
# 6925 Patel, Payal
NPI: 1790149193 LIC: 6925
# 3080 Richens, Bradley
NPI: 1437163078 LIC: 3080
# S6-120 Salar, Behnam
NPI: 1629326400 LIC: S6-120
# 6463 Truong, Vanna
NPI: 1629400130 LIC: 6463
# 7137 Wong, Joel
NPI: 1962987602 LIC: 7137
# 2901022360 Zeitoun, Ali
NPI: 1346761368 LIC: 2901022360
#016523
Children's Dentistry of Paradise
2480 E. Tompkins Ave #102
Las Vegas, NV 89121
(702) 903-2238
English, Spanish
M-T 8am-4pm
Th-F 8am-4pm
S 8am - 4pm
# 4334 Barbin, Francesca
NPI: 1689758252 LIC: 4334
# 6866 Borghei, Sarah
NPI: 1447796636 LIC: 6866
# 6754 Campbell, Amanda
NPI: 1831504612 LIC: 6754
# 5929 Delisle, Steven
NPI: 1639329337 LIC: 5929
# 6752 Delisle, Nicholas
NPI: 1073963385 LIC: 6752
# 6024 Gandotra, Vivek
NPI: 1013054931 LIC: 6024
# 6831 Kim, Eugene
NPI: 1306361845 LIC: 6831
# 5606 Lebroke, Ronald
NPI: 1336310309 LIC: 5606
# 6549 Lee, Steven
NPI: 1538569389 LIC: 6549
# 6830CA Lim, Jason
NPI: 1184980955 LIC: 6830CA
# 6659 Mismas, Rachel
NPI: 1619015831 LIC: 6659
# 6841 Nguyen, Jack
NPI: 1700323839 LIC: 6841
# 6925 Patel, Payal
NPI: 1790149193 LIC: 6925
# 3080 Richens, Bradley
NPI: 1437163078 LIC: 3080
# S6-120 Salar, Behnam
NPI: 1629326400 LIC: S6-120
# 6463 Truong, Vanna
NPI: 1629400130 LIC: 6463
# 7137 Wong, Joel
NPI: 1962987602 LIC: 7137
# 2901022360 Zeitoun, Ali
NPI: 1346761368 LIC: 2901022360
#007203
Coast Dental - Spring Valley
8445 W Flamingo Rd
Las Vegas, NV 89147
(702) 948-7939
English
M-F 8am - 5pm
# 7010 Ellsworth, Evan
NPI: 1003314535 LIC: 7010
# 32697 Patel, Rahul
NPI: 1063969152 LIC: 32697
#011404
Complete Dental, LLC
2625 S. Rainbow Blvd, Ste #D-100
Las Vegas, NV 89146
(702) 227-5800
Spanish, English, Korean
M-Th 9am - 7pm
# 4759 Jin, Jong
NPI: 1720053374 LIC: 4759
#017136
Coronado Dental
7377 S Jones Blvd Ste 110
Las Vegas, NV 89139
(702) 382-2709
English, Vietnamese
M-T 9am-6pm
W-Th 9am-6pm
# 4322 Pham, Chi
NPI: 1285810317 LIC: 4322
#007106
Courtesy Dental & Orthodontics -
Centennial
7901 W Tropical Pkwy, Ste 120
Las Vegas, NV 89149
(702) 839-5030
Spanish
M-T 9am-5pm
Th-F 7am-3pm
# 6740 Atwal, Parminder
NPI: 1174938039 LIC: 6740
# 6336 Basta, Trevor
NPI: 1962753996 LIC: 6336
# 6675NV Dapra Jr., David
NPI: 1447633474 LIC: 6675NV
# 6368 Hashtroudi, Saman
NPI: 1740520188 LIC: 6368
# 6467 Myrin, Christina
NPI: 1881025476 LIC: 6467
#007110
Courtesy Dental & Orthodontics -
Charleston
320 N. Nellis Blvd, Ste 4
Las Vegas, NV 89110
(702) 453-7200
Spanish
T 8am - 6pm
W-F 8am-6pm
# 6740 Atwal, Parminder
NPI: 1174938039 LIC: 6740
# 6336 Basta, Trevor
NPI: 1962753996 LIC: 6336
# 6675NV Dapra Jr., David
NPI: 1447633474 LIC: 6675NV
# 6368 Hashtroudi, Saman
NPI: 1740520188 LIC: 6368
# 6467 Myrin, Christina
NPI: 1881025476 LIC: 6467
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 14 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
#014615
Crowne Dental
8390 W. Sahara Ave, Ste 110
Las Vegas, NV 89117
(702) 804-1500
English, Spanish
M 7am - 3pm, T 8am - 5pm
W 12pm-6pm, Th 8am-5pm, F 7am-1pm
# 5577 Reese, Truvella
NPI: 1083803241 LIC: 5577
#016478
Decatur Children's Dental
1111 N. Decatur Blvd
Las Vegas, NV 89108
(702) 636-5553
English, Spanish
T 10am - 7pm
W-Th 10am-7pm
# 6678 Alhwayek, Christelle
NPI: 1265817456 LIC: 6678
# 5606 Lebroke, Ronald
NPI: 1336310309 LIC: 5606
#016755
Dental Care International
1750 Wheeler Peak Dr
Las Vegas, NV 89106
(702) 272-1100
English, Spanish, Vietnamese
M-F 8am - 5pm
# 7141 Kim, Christine
NPI: 1518442086 LIC: 7141
# 6463 Truong, Vanna
NPI: 1629400130 LIC: 6463
# 7191 Vert, Joshua
NPI: 1780117036 LIC: 7191
#007029
Dental Hispana
4800 Alpine Pl., Ste 1
Las Vegas, NV 89107
(702) 870-6362
Spanish
M-F 9am - 5pm
# 4308 Perez, Liselott Ana
NPI: 1932131406 LIC: 4308
#007316
Dental Nation Inc
3255 S. Eastern Ave
Las Vegas, NV 89169
(702) 642-8101
Spanish, Tagalog
M-T 8am-5pm
W-Th 8am-5pm
# 5852 Black, Kline
NPI: 1881823789 LIC: 5852
#017069
Dental Now
6116 W. Flamingo Rd
Las Vegas, NV 89103
(702) 369-5551
English, Spanish, Vietnamese
M 9am - 6pm,
W 9am-6pm,
S 9am - 2pm
# 5696 Dang, Thuong
NPI: 1487606364 LIC: 5696
#007211
Discount Dental
60 N. 25Th St, Ste 110
Las Vegas, NV 89101
(702) 386-8811
English, Spanish
M 9am - 5pm, T 10am - 6pm
W 10am-6pm, Th 11am-7pm, F 9am-5pm
S 9am - 5pm
# 7007NV Bowen, Douglas
NPI: 1114446564 LIC: 7007NV
# 4883 Cappiello, Aida
NPI: 1639217466 LIC: 4883
# 6902NV Chi, Hyunseok
NPI: 1124258736 LIC: 6902NV
# 3046 Chin, Harvey
NPI: 1558538090 LIC: 3046
# 6937 Cho, Alan
NPI: 1710400858 LIC: 6937
# 4274 Chung, David
NPI: 1962505875 LIC: 4274
# 32232 Dao, Alexander
NPI: 1881148344 LIC: 32232
# 6904 Galada, Michael
NPI: 1134559636 LIC: 6904
# 6558 Goshimea, Dawit
NPI: 1821497900 LIC: 6558
# 6891 Ha, Annie
NPI: 1487095279 LIC: 6891
# 4552 Hang, John
NPI: 1033261185 LIC: 4552
# 3072 Justice, Glenn
NPI: 1790716355 LIC: 3072
# 6813 Lee, Charles
NPI: 1306143847 LIC: 6813
# 6821 Lee, Teresa
NPI: 1659825628 LIC: 6821
# 4170 Morris, Steven
NPI: 1891903308 LIC: 4170
# 6841 Nguyen, Jack
NPI: 1700323839 LIC: 6841
# 4751NV Pak, Minyoung
(Jonathan)
NPI: 1679776413 LIC: 4751NV
# 6637NV Phui, Andy
NPI: 1811371818 LIC: 6637NV
# 3063 Ponce, Monica
NPI: 1174598882 LIC: 3063
# 6496 Pritz, Norma
NPI: 1962825448 LIC: 6496
# 6092 Rosales, Jon-Christopher
NPI: 1144503640 LIC: 6092
# 100268 Ruangjumrusvet, Chanon
NPI: 1285083287 LIC: 100268
# 6697 Saparam, Nischal
NPI: 1689838005 LIC: 6697
# 47660 Sayedna, Shahram
NPI: 1497890768 LIC: 47660
# 5737 Tiburcio, Don
NPI: 1962666719 LIC: 5737
# 3692 Ting, David
NPI: 1699887919 LIC: 3692
# 6641 Tran, Mason
NPI: 1679960611 LIC: 6641
#016798
Discovery Dental
2900 E. Desert Inn Road, Ste 109
Las Vegas, NV 89121
(702) 750-0933
English, Spanish
M-F 8am - 5pm
# 2372 Kuiava, Timothy
NPI: 1497968812 LIC: 2372
# 5801 Virtuoso, Armand
NPI: 1447499173 LIC: 5801
#016777
Dr. B's Dentistry For Children
5705 Centennial Center Blvd Ste 140
Las Vegas, NV 89149
(702) 998-7100
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# S6-107 Baggaley, Todd
NPI: 1831347384 LIC: S6-107
# 6648 Hyer, Chandler
NPI: 1083090864 LIC: 6648
#011939
Dr. Michael Wendelboe, DMD, PC
7260 W. Azure, Ste 110
Las Vegas, NV 89130
(702) 821-1688
English
M-T 8am-5pm
W 8am-5pm,
# 5569 Wendelboe, Michael
NPI: 1689866766 LIC: 5569
#FQHC007122
Eastern Family Medical & Dental
Center
2212 S. Eastern Ave
Las Vegas, NV 89104
(702) 597-3898
English, Spanish
M-F 7am - 6pm
# 5952 Anwar, Adeel
NPI: 1245470913 LIC: 5952
# 3471 Davis, Tyree
NPI: 1750468310 LIC: 3471
# 2644NV Shin, Eunsook
NPI: 1881794204 LIC: 2644NV
#017105
Eastern Hills Family Dental LLC
5905 S. Eastern Ave, Ste 112
Las Vegas, NV 89119
(702) 262-5693
English, Spanish
M-T 8am-6pm
W 8am-6pm, Th 8am-5pm, F 8am-3pm
# 5876 Mathisen, Deanna
NPI: 1457678864 LIC: 5876
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 15 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
#007086
Eastwind Dental
2075 East Windmill Lane Ste 110
Las Vegas, NV 89123
(702) 877-2378
Vietnamese, Spanish
M-F 8am - 5pm
# 4837 Nguyen, Thong
NPI: 1427183953 LIC: 4837
#016757
First Dentists, LLC
69 N. Nellis Blvd
Las Vegas, NV 89110
(702) 207-1122
English, Korean, Spanish
M-F 9am - 6pm
# 6331 Rha, Chi
NPI: 1376649616 LIC: 6331
# 6641 Tran, Mason
NPI: 1679960611 LIC: 6641
#007179
Happy Dental
6707 W. Charleston Blvd, Ste 1A
Las Vegas, NV 89146
(702) 438-0888
English, Spanish, Cantonese,
Mandarin
M-F 9am - 5pm
# 6902NV Chi, Hyunseok
NPI: 1124258736 LIC: 6902NV
#019269
Happy Smiles Dental Group
2585 S. Jones Blvd Ste 1B
Las Vegas, NV 89146
(702) 476-6767
English, Spanish, Portuguese
M-T 8am-5pm
W-Th 8am-5pm
S 8am - 1pm
# 5801 Virtuoso, Armand
NPI: 1447499173 LIC: 5801
# 4273 Wilson, Scott
NPI: 1700955853 LIC: 4273
#018282
Herrera Family Dental, PLLC
1300 S. Lamb Blvd Ste 400
Las Vegas, NV 89104
(702) 780-7660
English, Spanish
M 11am - 7pm, T 10am - 6pm
S 8am - 2pm
# 6786 Herrera, Evelyn
NPI: 1699126094 LIC: 6786
#016739
Hollywood Smile Dental
2425 E. Tropicana Ave
Las Vegas, NV 89121
(702) 240-9200
Korean, Spanish, Tagalog, Vietnamese
M 9am - 6pm, T 9am - 4pm
Th-F 9am-4pm
S-Su 9am-1pm
# 6140 Kim, Min
NPI: 1629380936 LIC: 6140
#007162
Hue Dental
1350 S. Jones Blvd, Ste 140
Las Vegas, NV 89146
(702) 870-6161
Portuguese, Korean, Spanish, Tagalog
M-F 9am - 6pm
# 5058 Dos Santos, Luiz
NPI: 1235250796 LIC: 5058
# 6956 Jun, Soo
NPI: 1447773346 LIC: 6956
# 7114 Traeger, Crystal
NPI: 1285110528 LIC: 7114
#FQHC016940
Huntridge Dental Center
2100 S. Maryland Pkwy Ste 5
Las Vegas, NV 89104
(702) 575-0866
English, Spanish
M-F 8am - 5pm
# 5695 Anwar, Lubna
NPI: 1326209586 LIC: 5695
#016483
iCare Dental
931 S. Decatur Blvd
Las Vegas, NV 89107
(702) 551-4224
English, Spanish, Vietnamese
M 9am - 6pm,
W 9am-6pm,
S 9am - 3pm
# 4328 Do, Thanh
NPI: 1578788139 LIC: 4328
# 6980NV Huynh, Tram
NPI: 1053849893 LIC: 6980NV
# 3776 Le, Tuan
NPI: 1982788261 LIC: 3776
#016511
iCare Dental
4301 S. Nellis Blvd
Las Vegas, NV 89121
(702) 456-8118
Spanish, English, Vietnamese
M-F 9am - 6pm
# 6980NV Huynh, Tram
NPI: 1053849893 LIC: 6980NV
# 3776 Le, Tuan
NPI: 1982788261 LIC: 3776
#007080
Ivy Dental, Inc.
740 N. Eastern Ave., Ste 120
Las Vegas, NV 89101
(702) 678-6218
Spanish, Chinese Mandarin
M-T 8am-5pm
W-Th 8am-5pm
# 3515 Wu, Jennifer
NPI: 1841346343 LIC: 3515
#011795
Kids' Dental Safari
2381 Renaissance Dr, Ste B
Las Vegas, NV 89119
(702) 786-6684
English, Farsi, Spanish
M-T 8am-4pm
W-Th 8am-4pm
# 2260 Isom, Blair
NPI: 1326267451 LIC: 2260
#017910
Las Vegas Smile Center
6600 W. Charleston Blvd Ste 103
Las Vegas, NV 89146
(702) 433-6825
English, Farsi, Spanish, Tagalog
M-T 9am-5pm
W-Th 8am-4pm
# 4514 Keshmiri, Shiva
NPI: 1174683585 LIC: 4514
# 6192NV Legaspi, Catherine
NPI: 1558638353 LIC: 6192NV
#014295
Love Dental
5680 W. Flamingo Rd Ste A
Las Vegas, NV 89103
(702) 876-3222
English, Korean, Mandarin, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# 6529 Baek, Julia
NPI: 1528475894 LIC: 6529
# 6754 Campbell, Amanda
NPI: 1831504612 LIC: 6754
#007051
Matteucci Family Dental
2764 Lake Sahara Drive, Ste 107
Las Vegas, NV 89117
(702) 365-6499
English, Spanish
M-T 8am-5pm
W 8am-5pm, Th 8am-2pm, F 8am-5pm
# NV6100 Matteucci, Matthew
NPI: 1972899391 LIC: NV6100
#007018
Moore Family Dentistry
2560 S. Maryland Pkwy, Ste 5
Las Vegas, NV 89109
(702) 791-1010
English, Spanish
M-T 8am-5pm
W 8am-5pm, Th 7am-4pm
# 3364 Moore, David
NPI: 1407875727 LIC: 3364
# 0966 Moore, Michael
NPI: 1477681922 LIC: 0966
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 16 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
#017885
Mountain West Dental Specialists
6970 S. Cimarron St. #100
Las Vegas, NV 89113
(702) 899-3600
English, Spanish, Tagalog
M-F 8am - 5pm
# S6-147 Tomlin, Keaton
NPI: 1841608379 LIC: S6-147
#019152
Mountain's Edge Pediatric
Dentistry
8520 Blue Diamond Rd #130
Las Vegas, NV 89178
(702) 463-4042
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# S6-107 Baggaley, Todd
NPI: 1831347384 LIC: S6-107
# 6648 Hyer, Chandler
NPI: 1083090864 LIC: 6648
# S6-169 Neu, Travis
NPI: 1467801183 LIC: S6-169
#007097
My Care Dental
4045 S Buffalo Dr Ste A-102
Las Vegas, NV 89147
(702) 221-4236
English, Spanish, Vietnamese
M-F 9am - 6pm
# 4592 Do, Tuyen
NPI: 1831234541 LIC: 4592
#016817
Neighborhood Dental
5061 E. Sahara Ave Ste 1A
Las Vegas, NV 89142
(702) 641-8868
English, Spanish, Vietnamese
M-T 9am-6pm
W 9am-6am,
# 4632 Ngo, Thanh
NPI: 1811095870 LIC: 4632
# 5483 Phan, Dawna
NPI: 1417086661 LIC: 5483
#015850
Nevada Dentistry & Braces
4492 S. Pecos Rd
Las Vegas, NV 89121
(702) 701-7999
English, Farsi, Spanish
M-F 9am - 6pm
# 6618 Abdoulin, Arthur
NPI: 1942605464 LIC: 6618
# 6790 Khorshad, Daniel
NPI: 1255772182 LIC: 6790
# 6641 Tran, Mason
NPI: 1679960611 LIC: 6641
#007104
New Image Dental
3885 S. Decatur Blvd, Ste 1100
Las Vegas, NV 89103
(702) 838-3311
Hindi, English, Panjabi, Spanish
M 9am - 7pm, T 9am - 5pm
W 9am-5pm,
# 6784NV Brar, Puneet
NPI: 1700257417 LIC: 6784NV
#016698
Palm Valley Dental
1985 N. Nellis Blvd
Las Vegas, NV 89115
(702) 531-3777
Arabic, English, Spanish
T 10am - 7pm
W 10am-7pm,
S 9am - 4pm
# 7181NV Burk, James
NPI: 1740265180 LIC: 7181NV
# 7127 Bush, Rachel
NPI: 1609350545 LIC: 7127
# 6393 Hoang, Lisa
NPI: 1881971869 LIC: 6393
# 5814 Huynh, James
NPI: 1144452996 LIC: 5814
# 6956 Jun, Soo
NPI: 1447773346 LIC: 6956
# 6679 Le, Phuong
NPI: 1093198533 LIC: 6679
# 6626 Lee, Philip
NPI: 1538540380 LIC: 6626
# 6928 Martz, Ryan
NPI: 1265954341 LIC: 6928
# 6929 Pham, Yves
NPI: 1568985042 LIC: 6929
# 5745 Redlinger, Jeffrey
NPI: 1285875229 LIC: 5745
# 5586 Tran, My
NPI: 1184882847 LIC: 5586
# 6941 Tran, Halan
NPI: 1538682752 LIC: 6941
# 61686 Viet, Ho
NPI: 1710274204 LIC: 61686
# 6773 Viravongsa, Christopher
NPI: 1982056818 LIC: 6773
#007236
Paradise Village Dental
518 E. St. Louis Ave, Ste A
Las Vegas, NV 89104
(702) 735-1096
English, Spanish, Vietnamese
M 10am - 6pm,
W 10am-6pm,
# 4709 Nguyen, Trang
NPI: 1902970775 LIC: 4709
#007138
Parkway Dental
210 S. Maryland Pkwy, Ste A
Las Vegas, NV 89101
(702) 384-3461
English, Spanish, Tagalog
M-T 9am-7pm
Th-F 9am-7pm
S 8am - 2pm
# 4156 Mangapit, Ronrico
NPI: 1093813115 LIC: 4156
#007147
Planet Dental
4570 N. Rancho Dr, Ste 2
Las Vegas, NV 89130
(702) 656-9497
English, Spanish, Vietnamese
M-Th 9am - 6pm
# 4603 Nguyen, Khanh Tuan
NPI: 1831146372 LIC: 4603
# 4760T Nguyen, Hop
NPI: 1457569873 LIC: 4760T
#007237
Pure Dental
4250 S. Rainbow Blvd, Ste 1004-1005
Las Vegas, NV 89103
(702) 456-4600
English, Spanish, Vietnamese
M 8am - 6pm, T 10am - 6pm
Th-F 10am-6pm
S 10am - 6pm
# 4709 Nguyen, Trang
NPI: 1902970775 LIC: 4709
#010374
Rancho Dental
1070 North Rancho Drive
Las Vegas, NV 89106
(702) 648-3701
English, Spanish
M-Th 9am - 6pm
# 5957 Suarez, Virginia
NPI: 1033296652 LIC: 5957
#011937
Regent Dental, LLC
1780 N. Buffalo Dr, Ste 109
Las Vegas, NV 89128
(702) 796-0808
English, Spanish, Chamic languages,
Tagalog, Vietnamese
M-F 8am - 5pm
# 4816 Chen, Richard
NPI: 1235104415 LIC: 4816
#007066
Sahara Dental Professionals
4121 W. Sahara Ave.
Las Vegas, NV 89102
(702) 257-9090
English, Spanish, Persian (T), Tagalog
M-T 9am-5pm
W-Th 9am-5pm
# 4514 Keshmiri, Shiva
NPI: 1174683585 LIC: 4514
# 6192NV Legaspi, Catherine
NPI: 1558638353 LIC: 6192NV
# 5804 Patterson, Jacqueline
NPI: 1790939403 LIC: 5804
# 6545NV Sidhu, Amandeep
NPI: 1700182763 LIC: 6545NV
# 6825 Singh, Amina
NPI: 1972052769 LIC: 6825
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 17 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
#007226
Sahara Jones Dental
2375 S. Jones Blvd, Ste 12A
Las Vegas, NV 89146
(702) 365-6441
Vietnamese
M-Th 10am - 5pm
# 2362 Trinh, Hoa
NPI: 1871633792 LIC: 2362
#012338
Salud Dental
6520 E. Lake Mead Blvd, Ste 105
Las Vegas, NV 89156
(702) 757-6577
English, Spanish
M-T 10am-6pm
W 10am-6pm, Th 8am-6pm, F 10am-6pm
S 9am - 3pm
# 6403 Betancourt-Preval, Edgar
NPI: 1144662693 LIC: 6403
#006482
Silver State Dental
4555 S. Fort Apache Rd Ste 136
Las Vegas, NV 89147
(702) 388-8979
English, Chinese Mandarin, Mandarin
M-Th 9am - 6pm
# 4507 Young, Mon-Han
NPI: 1730258443 LIC: 4507
#018032
Simply Wisdom Teeth
8954 Spanish Ridge Ave #3
Las Vegas, NV 89148
(702) 832-0123
English, Spanish
# 143297 Hendrickson, Ivan
NPI: 1003079260 LIC: 143297
# 6788NV Plumb, William
NPI: 1437484698 LIC: 6788NV
#006542
Skyline Dental
6430 W Lake Mead Blvd Ste 140
Las Vegas, NV 89108
(702) 647-3377
English, Spanish, Vietnamese
M-T 9am-6pm
W 9am-6pm,
S 8am - 3pm
# 4873 Chau, Man
NPI: 1366491409 LIC: 4873
#016609
Smile Care Professionals
6386 W Sahara Ave, Ste 6388
Las Vegas, NV 89146
(702) 288-7200
English, Spanish, Portuguese, Tagalog
M-F 9am - 6pm
# 6314NV Garner, Staci
NPI: 1215283056 LIC: 6314NV
# S6-108 Manuel, Renalie
NPI: 1902952070 LIC: S6-108
# 5070 Navales, Christine
NPI: 1497911564 LIC: 5070
# 4493 Spengler, Sandra
NPI: 1144232976 LIC: 4493
# 4273 Wilson, Scott
NPI: 1700955853 LIC: 4273
# 5806 Zhou, Wenlian
NPI: 1144451592 LIC: 5806
#007083
Smile Haven Family Dentistry
4045 S. Eastern Ave.
Las Vegas, NV 89119
(702) 892-9878
Spanish, Chinese Mandarin
M-F 8am - 5pm
# 5037 Hsieh, Jason
NPI: 1164649851 LIC: 5037
# 4996T Ku, Koshiu
NPI: 1225225352 LIC: 4996T
#019281
Smile On Dentistry
9775 West Sunst Road #103
Las Vegas, NV 89148
(725) 400-4002
English, Spanish
M-T 8am-6pm
W-Th 8am-6pm
S 9am - 2pm
# 6314NV Garner, Staci
NPI: 1215283056 LIC: 6314NV
#016981
Smile Reef Pediatric Dentistry
9500 W. Flamingo Rd Ste 200
Las Vegas, NV 89147
(702) 570-7333
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# S6-100 Jensen, Jaren
NPI: 1225207251 LIC: S6-100
# S6-126C Lamb, Christopher
NPI: 1154558815 LIC: S6-126C
# S6-160 Vaughn, Andrew
NPI: 1568692242 LIC: S6-160
#014253
Smiles 4 U
3211 S. Eastern Ave
Las Vegas, NV 89169
(702) 802-3500
English, Spanish, Vietnamese
M-T 9am-6pm
Th-F 9am-6pm
S 9am - 3pm
# NV4555 Trinh, Thomas
NPI: 1225202849 LIC: NV4555
#016702
South View Dental
9210 S. Eastern Ave #130M
Las Vegas, NV 89123
(702) 492-1564
English, Russian, Polish, Spanish
T 9am - 6pm
W 9am-2pm, Th 10am-7pm, F 12pm-5pm
S 9am - 4pm
# 2631 Betancourt, Damian
NPI: 1699813865 LIC: 2631
# 6784NV Brar, Puneet
NPI: 1700257417 LIC: 6784NV
# 7058 Chang, Ning
NPI: 1003265091 LIC: 7058
# 6393 Hoang, Lisa
NPI: 1881971869 LIC: 6393
# 5814 Huynh, James
NPI: 1144452996 LIC: 5814
# 6956 Jun, Soo
NPI: 1447773346 LIC: 6956
# 6679 Le, Phuong
NPI: 1093198533 LIC: 6679
# 6626 Lee, Philip
NPI: 1538540380 LIC: 6626
# 6928 Martz, Ryan
NPI: 1265954341 LIC: 6928
# 6929 Pham, Yves
NPI: 1568985042 LIC: 6929
# 5745 Redlinger, Jeffrey
NPI: 1285875229 LIC: 5745
# 6131NV Tounian, Arvin
NPI: 1467639005 LIC: 6131NV
# 6941 Tran, Halan
NPI: 1538682752 LIC: 6941
# 61686 Viet, Ho
NPI: 1710274204 LIC: 61686
# 6773 Viravongsa, Christopher
NPI: 1982056818 LIC: 6773
#016662
Star Brite Dental
6720 N Durango Dr Ste 260
Las Vegas, NV 89149
(702) 893-2288
English, Spanish, Vietnamese
M 8am - 5pm, T 8am - 12pm
W-F 8am-5pm
S 8am - 3pm
# 4623 Xa, Trung
NPI: 1801827605 LIC: 4623
#014412
Star Dental
4542 E. Tropicana Ave
Las Vegas, NV 89121
(702) 433-7827
English, Spanish, Tagalog, Vietnamese
M-F 8am - 6pm
# 4922 Nguyen, Hien
NPI: 1730274044 LIC: 4922
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 18 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
#006619
Stars Dental
5840 W Craig Rd Ste 130
Las Vegas, NV 89130
(702) 395-3047
Vietnamese, Spanish
M-T 9am-6pm
W-Th 9am-6pm
# 4890 Chiem, Wendy
NPI: 1902965809 LIC: 4890
#013627
Stars Dental Inc.
7910 S. Rainbow Blvd Ste 125
Las Vegas, NV 89139
(702) 457-7858
English, Spanish, Chinese (T),
Vietnamese
M-T 9am-5pm
W 9am-5pm,
S 9am - 2pm
# 4935 Chiem, Peter
NPI: 1285793182 LIC: 4935
#016293
Su Familia Dental
4161 South Eastern Ave, Ste E8
Las Vegas, NV 89119
(702) 233-1222
English, Spanish
M-T 9am-5pm
Th-F 9am-5pm
# 43745 Afshari, Nader
NPI: 1063696110 LIC: 43745
# 6667 Irani Rohani, Mahzarine
NPI: 1366862179 LIC: 6667
#014413
The Dental Center of Nevada
601 S Rancho Dr Ste B15
Las Vegas, NV 89106
(702) 385-1166
English, Spanish, Tagalog
M-T 9am-6pm
W 9am-6am, Th 9am-6pm, F 9am-3pm
S 8am - 2pm
# 4685 Paleracio, Philip (Felipe)
NPI: 1851366413 LIC: 4685
#016644
Thomas S. Matteucci, DDS
2764 Lake Sahara #107
Las Vegas, NV 89117
(702) 365-6499
English, Spanish
M-T 8am-5pm
W 8am-5pm, Th 8am-2pm, F 8am-5pm
# 2334 Matteucci, Thomas
NPI: 1235147695 LIC: 2334
#016901
Thunderbird Dental
3603 Las Vegas Blvd North Ste 120
Las Vegas, NV 89115
(702) 545-0055
English, Spanish, Tagalog
M-F 8am - 5pm
# 6754 Campbell, Amanda
NPI: 1831504612 LIC: 6754
# 5876 Mathisen, Deanna
NPI: 1457678864 LIC: 5876
#007305
Tower Dental
512 E. Saint Louis Ave
Las Vegas, NV 89104
(702) 894-9858
Korean, Spanish
M 1pm - 5pm, T 8am - 5pm
, F 8am-12pm
# 3518 Lee, David
NPI: 1457495772 LIC: 3518
# 4073 Lee, Keon
NPI: 1154535250 LIC: 4073
#017197
Tri Manh Nguyen DDS Inc
6820 W Flamingo Rd Ste I
Las Vegas, NV 89103
(702) 222-4330
English, Spanish, Vietnamese
M-T 9am-5pm
Th-F 9am-5pm
# 04368 Nguyen, Tri
NPI: 1770594293 LIC: 04368
#007303
Tropicana Dental
4855 S. Pecos Road, Ste B-1
Las Vegas, NV 89121
(702) 434-0725
Spanish
W 8am-5pm, Th 8am-12pm
# 3517 Carahalis, John
NPI: 1124162383 LIC: 3517
# 3518 Lee, David
NPI: 1457495772 LIC: 3518
# 4073 Lee, Keon
NPI: 1154535250 LIC: 4073
#017154
UNLV School Dental Medicine
Faculty Dental Practice-School B
1700 W. Charleston Blvd. Bldg. D
Las Vegas, NV 89102
(702) 774-8000
English
M-F 9am - 5pm
# LL-464-18 Cui, Xiaoxi
NPI: 1124524145 LIC: LL-464-18
# LL-139-06 Everett, Rhonda
NPI: 1629274121 LIC: LL-139-06
# 3748 Mcalpine, George
NPI: 1871655969 LIC: 3748
# 5993 Okundaye, Amanda
NPI: 1700044781 LIC: 5993
# 0588 Rawson, Raymond
NPI: 1487779336 LIC: 0588
# 0967 Rosenbaum, George
NPI: 1770742561 LIC: 0967
# 7106NV Tang, Van
NPI: 1649775271 LIC: 7106NV
# 7110 Tran, Eliza
NPI: 1184151045 LIC: 7110
# 5806 Zhou, Wenlian
NPI: 1144451592 LIC: 5806
#017157
UNLV School Dental Medicine
SDM on Main- School Based
4505 S. Maryland Parkway
Las Vegas, NV 89154
(702) 774-7108
English
M-F 9am - 5pm
# 3322 Brandon, Tina
NPI: 1154356806 LIC: 3322
# 3748 Mcalpine, George
NPI: 1871655969 LIC: 3748
#017153
UNLV School of Dental Medicine
Advance Pediatrics-School Bas
1700 W. Charleston Blvd Bldg. A
Las Vegas, NV 89102
(702) 774-2415
English
M-F 9am - 5pm
# 3203 Bruno, Frank
NPI: 1447390224 LIC: 3203
# 6045 Fox, Gerald
NPI: 1124091608 LIC: 6045
# 3748 Mcalpine, George
NPI: 1871655969 LIC: 3748
# 5806 Zhou, Wenlian
NPI: 1144451592 LIC: 5806
#017152
UNLV School of Dental Medicine
DDS Practice- School Based
1700 W. Charleston Blvd. Bldg. A
Las Vegas, NV 89102
(702) 774-5429
English
M-F 9am - 5pm
# 6439 Anderson, Ashley
NPI: 1265872469 LIC: 6439
# 3203 Bruno, Frank
NPI: 1447390224 LIC: 3203
# 6045 Fox, Gerald
NPI: 1124091608 LIC: 6045
# 3748 Mcalpine, George
NPI: 1871655969 LIC: 3748
# 2063 Thiriot, Rick
NPI: 1093848178 LIC: 2063
# 5806 Zhou, Wenlian
NPI: 1144451592 LIC: 5806
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 19 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
#017156
UNLV School of Dental Medicine
General Practice- School Base
1700 W. Charleston Blvd Bldg D
Las Vegas, NV 89102
(702) 774-5175
English
M-F 9am - 5pm
# 6439 Anderson, Ashley
NPI: 1265872469 LIC: 6439
# 3203 Bruno, Frank
NPI: 1447390224 LIC: 3203
# 6045 Fox, Gerald
NPI: 1124091608 LIC: 6045
# 3748 Mcalpine, George
NPI: 1871655969 LIC: 3748
# 2063 Thiriot, Rick
NPI: 1093848178 LIC: 2063
# 5806 Zhou, Wenlian
NPI: 1144451592 LIC: 5806
#017155
UNLV School of Dental Medicine
Orthodontics Program- School
1700 W. Charleston Blvd. Bldg. D
Las Vegas, NV 89102
(702) 774-2690
English
M-F 9am - 5pm
# 3748 Mcalpine, George
NPI: 1871655969 LIC: 3748
# 5806 Zhou, Wenlian
NPI: 1144451592 LIC: 5806
#017151
UNLV School of Dental Medicine-
School Based
1700 W. Charleston Blvd. Bldg A
Las Vegas, NV 89102
(702) 774-2400
English
M-F 9am - 5pm
# 6439 Anderson, Ashley
NPI: 1265872469 LIC: 6439
# 3203 Bruno, Frank
NPI: 1447390224 LIC: 3203
# 6045 Fox, Gerald
NPI: 1124091608 LIC: 6045
# 4787 Hurlbut, Bernard
NPI: 1568536258 LIC: 4787
# 6667 Irani Rohani, Mahzarine
NPI: 1366862179 LIC: 6667
# 3748 Mcalpine, George
NPI: 1871655969 LIC: 3748
# 4173NV Raybeck, Gerald
NPI: 1669430443 LIC: 4173NV
# 2063 Thiriot, Rick
NPI: 1093848178 LIC: 2063
# 5806 Zhou, Wenlian
NPI: 1144451592 LIC: 5806
#016663
Urgent Dental LLC
500 E. Windmill Lane #130
Las Vegas, NV 89123
(702) 228-1106
English
M-F 9am - 6pm
# 5795 Atwood, Aaron
NPI: 1467692228 LIC: 5795
#007304
V.I.P. Dental
3050 E. Desert Inn Road, Ste 105
Las Vegas, NV 89121
(702) 732-7616
Korean, Spanish
M-T 8am-1pm
W 8am-5pm,
# 3518 Lee, David
NPI: 1457495772 LIC: 3518
#016712
Vegas Family Dental LLC
2840 E. Flamingo Rd, Ste G
Las Vegas, NV 89121
(702) 224-2762
English, Tagalog
W-Th 9am-6pm
# 5795 Atwood, Aaron
NPI: 1467692228 LIC: 5795
#006550
Viva Dental
840 N. Decatur Blvd Ste H
Las Vegas, NV 89107
(702) 432-8482
Vietnamese, Spanish
M-F 9am - 5pm
# 4732 Nguyen, Diem
NPI: 1417971672 LIC: 4732
#010284
Wirig Orthodontics
4610 Meadows Ln, Ste A
Las Vegas, NV 89107
(702) 482-8299
English, Spanish
M-T 8am-6pm
W-Th 8am-6pm
# S6-96 Bybee, Ryan
NPI: 1457541997 LIC: S6-96
# 6539 Wirig, Spencer
NPI: 1801948484 LIC: 6539
LOGANDALE
#017251
Valley Pediatric Dental
3310 Moapa Valley Blvd
Logandale, NV 89021
(888) 963-9601
English, Spanish
W-F 7am-4pm
# 8982123-9923 Higbee, Jeffrey
NPI: 1942565486 LIC: 8982123-9923
MESQUITE
#017122
Mesquite Family Dental
61 N. Willow St Ste 1
Mesquite, NV 89027
(702) 346-2882
Spanish
M-F 8am - 4pm
# 6359 Marchant, David
NPI: 1780979245 LIC: 6359
# 6932 White, Trevor
NPI: 1548798481 LIC: 6932
NORTH LAS VEGAS
#007258
Absolute Dental & Orthodontics
2301 E. Lake Mead Blvd
North Las Vegas, NV 89030
(702) 331-8338
English, Spanish
M 9am - 6pm, T 7am - 3pm
W-F 9am-6pm
# 5802 Abdou, Mary
NPI: 1689805939 LIC: 5802
# 5695 Anwar, Lubna
NPI: 1326209586 LIC: 5695
# 31436 Browne, Morgan
NPI: 1316316706 LIC: 31436
# S6-164 Cao, Michael
NPI: 1679020622 LIC: S6-164
# 32232 Dao, Alexander
NPI: 1881148344 LIC: 32232
# 32909 Dao, Minhquan
NPI: 1477082717 LIC: 32909
# 6962 Davidowitz, Rachelle
NPI: 1629594940 LIC: 6962
# 6328 Farokh, Samira
NPI: 1497091367 LIC: 6328
# 51777 Fellars, David
NPI: 1659555076 LIC: 51777
# 6063 Guideng, Romulo
NPI: 1174824148 LIC: 6063
# 7124NV Hess, Trevor
NPI: 1831507482 LIC: 7124NV
# S6-165 Hon, Larry
NPI: 1114378866 LIC: S6-165
# 5814 Huynh, James
NPI: 1144452996 LIC: 5814
# 5477 Khairah, Gurpreet
NPI: 1659599280 LIC: 5477
# 5038 Landron, Joan
NPI: 1003892126 LIC: 5038
# S6-108 Manuel, Renalie
NPI: 1902952070 LIC: S6-108
# 3716 Mcintosh, Vivi
NPI: 1124238662 LIC: 3716
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# 25566 Nghiem, Audrey
NPI: 1700190790 LIC: 25566
# 4886 Nguyen, Man
NPI: 1760562557 LIC: 4886
# 7133 Nielson, France
NPI: 1083924971 LIC: 7133
# 5713 Patel, Sarika
NPI: 1346406808 LIC: 5713
# D07110 Peterson, Steven
NPI: 1477600666 LIC: D07110
# 6931 Petrie, Natasha
NPI: 1255795928 LIC: 6931
# 5483 Phan, Dawna
NPI: 1417086661 LIC: 5483
# 4415 Porter, Stansby
NPI: 1851425482 LIC: 4415
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 20 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
# 101448 Pour, Hamid
NPI: 1174043764 LIC: 101448
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
# 7107NV Rezapour, Noura
NPI: 1194205625 LIC: 7107NV
# 6697 Saparam, Nischal
NPI: 1689838005 LIC: 6697
# 6894 Shahrokh, Pouyan
NPI: 1013354927 LIC: 6894
# 6949 Sharma, Akanksha
NPI: 1164944278 LIC: 6949
# 4493 Spengler, Sandra
NPI: 1144232976 LIC: 4493
# S5-50C Trinh, Owen
NPI: 1164806907 LIC: S5-50C
# 6776 Vann, Stephen
NPI: 1003035437 LIC: 6776
# 6773 Viravongsa, Christopher
NPI: 1982056818 LIC: 6773
# 5090 Wilson, Jeremy
NPI: 1023186095 LIC: 5090
# 6509 Yap, Kimberly
NPI: 1255615803 LIC: 6509
#007267
Absolute Dental & Orthodontics
5892 Losee Rd Ste 135
North Las Vegas, NV 89081
(702) 399-8700
English, Spanish
T 8am - 5pm
W-Th 8am-5pm
S 9am - 3pm
# 5802 Abdou, Mary
NPI: 1689805939 LIC: 5802
# 5695 Anwar, Lubna
NPI: 1326209586 LIC: 5695
# 31436 Browne, Morgan
NPI: 1316316706 LIC: 31436
# S6-164 Cao, Michael
NPI: 1679020622 LIC: S6-164
# 32232 Dao, Alexander
NPI: 1881148344 LIC: 32232
# 32909 Dao, Minhquan
NPI: 1477082717 LIC: 32909
# 6962 Davidowitz, Rachelle
NPI: 1629594940 LIC: 6962
# 6328 Farokh, Samira
NPI: 1497091367 LIC: 6328
# 51777 Fellars, David
NPI: 1659555076 LIC: 51777
# 6063 Guideng, Romulo
NPI: 1174824148 LIC: 6063
# 7124NV Hess, Trevor
NPI: 1831507482 LIC: 7124NV
# S6-165 Hon, Larry
NPI: 1114378866 LIC: S6-165
# 5814 Huynh, James
NPI: 1144452996 LIC: 5814
# 5477 Khairah, Gurpreet
NPI: 1659599280 LIC: 5477
# 5038 Landron, Joan
NPI: 1003892126 LIC: 5038
# S6-108 Manuel, Renalie
NPI: 1902952070 LIC: S6-108
# 3716 Mcintosh, Vivi
NPI: 1124238662 LIC: 3716
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# 25566 Nghiem, Audrey
NPI: 1700190790 LIC: 25566
# 4886 Nguyen, Man
NPI: 1760562557 LIC: 4886
# 7133 Nielson, France
NPI: 1083924971 LIC: 7133
# 5713 Patel, Sarika
NPI: 1346406808 LIC: 5713
# D07110 Peterson, Steven
NPI: 1477600666 LIC: D07110
# 6931 Petrie, Natasha
NPI: 1255795928 LIC: 6931
# 5483 Phan, Dawna
NPI: 1417086661 LIC: 5483
# 4415 Porter, Stansby
NPI: 1851425482 LIC: 4415
# 101448 Pour, Hamid
NPI: 1174043764 LIC: 101448
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
# 7107NV Rezapour, Noura
NPI: 1194205625 LIC: 7107NV
# 6697 Saparam, Nischal
NPI: 1689838005 LIC: 6697
# 6894 Shahrokh, Pouyan
NPI: 1013354927 LIC: 6894
# 6949 Sharma, Akanksha
NPI: 1164944278 LIC: 6949
# 4493 Spengler, Sandra
NPI: 1144232976 LIC: 4493
# S5-50C Trinh, Owen
NPI: 1164806907 LIC: S5-50C
# 6776 Vann, Stephen
NPI: 1003035437 LIC: 6776
# 6773 Viravongsa, Christopher
NPI: 1982056818 LIC: 6773
# 5090 Wilson, Jeremy
NPI: 1023186095 LIC: 5090
# 6509 Yap, Kimberly
NPI: 1255615803 LIC: 6509
#016678
Absolute Dental & Orthodontics
2217 E. Lake Mead Blvd
North Las Vegas, NV 89030
(702) 641-5888
English, Spanish
M-F 9am - 6pm
# 5802 Abdou, Mary
NPI: 1689805939 LIC: 5802
# 5695 Anwar, Lubna
NPI: 1326209586 LIC: 5695
# 31436 Browne, Morgan
NPI: 1316316706 LIC: 31436
# S6-164 Cao, Michael
NPI: 1679020622 LIC: S6-164
# 6824 Culpepper, Marah
NPI: 1366992232 LIC: 6824
# 32232 Dao, Alexander
NPI: 1881148344 LIC: 32232
# 32909 Dao, Minhquan
NPI: 1477082717 LIC: 32909
# 6962 Davidowitz, Rachelle
NPI: 1629594940 LIC: 6962
# S6-118 Ezeanolue, Bibiana
NPI: 1356570998 LIC: S6-118
# 6328 Farokh, Samira
NPI: 1497091367 LIC: 6328
# 51777 Fellars, David
NPI: 1659555076 LIC: 51777
# 3732 Fu, Suzan
NPI: 1144238049 LIC: 3732
# 6063 Guideng, Romulo
NPI: 1174824148 LIC: 6063
# 6530 Han, Irene
NPI: 1639569064 LIC: 6530
# 7124NV Hess, Trevor
NPI: 1831507482 LIC: 7124NV
# S6-165 Hon, Larry
NPI: 1114378866 LIC: S6-165
# 5814 Huynh, James
NPI: 1144452996 LIC: 5814
# 5477 Khairah, Gurpreet
NPI: 1659599280 LIC: 5477
# 6942 Koscinski, Matt
NPI: 1093242232 LIC: 6942
# 5038 Landron, Joan
NPI: 1003892126 LIC: 5038
# S6-108 Manuel, Renalie
NPI: 1902952070 LIC: S6-108
# 3716 Mcintosh, Vivi
NPI: 1124238662 LIC: 3716
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# 25566 Nghiem, Audrey
NPI: 1700190790 LIC: 25566
# 4886 Nguyen, Man
NPI: 1760562557 LIC: 4886
# 7133 Nielson, France
NPI: 1083924971 LIC: 7133
# 5713 Patel, Sarika
NPI: 1346406808 LIC: 5713
# D07110 Peterson, Steven
NPI: 1477600666 LIC: D07110
# 6931 Petrie, Natasha
NPI: 1255795928 LIC: 6931
# 5483 Phan, Dawna
NPI: 1417086661 LIC: 5483
# 4415 Porter, Stansby
NPI: 1851425482 LIC: 4415
# 101448 Pour, Hamid
NPI: 1174043764 LIC: 101448
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
# 7107NV Rezapour, Noura
NPI: 1194205625 LIC: 7107NV
# 7132 Sanikop-Kori, Priyanka
NPI: 1780155820 LIC: 7132
# 6697 Saparam, Nischal
NPI: 1689838005 LIC: 6697
# 7109 Shah, Rahi
NPI: 1053897660 LIC: 7109
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 21 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
# 6894 Shahrokh, Pouyan
NPI: 1013354927 LIC: 6894
# 6949 Sharma, Akanksha
NPI: 1164944278 LIC: 6949
# S6-130 Shroff, Sulabh
NPI: 1811284243 LIC: S6-130
# 4493 Spengler, Sandra
NPI: 1144232976 LIC: 4493
# S5-50C Trinh, Owen
NPI: 1164806907 LIC: S5-50C
# 6776 Vann, Stephen
NPI: 1003035437 LIC: 6776
# 4582 Vernon, Jorge
NPI: 1447420476 LIC: 4582
# 6773 Viravongsa, Christopher
NPI: 1982056818 LIC: 6773
# 5090 Wilson, Jeremy
NPI: 1023186095 LIC: 5090
# 6509 Yap, Kimberly
NPI: 1255615803 LIC: 6509
#016679
Absolute Dental & Orthodontics
3040 W. Ann Rd Ste 101
North Las Vegas, NV 89031
(702) 839-2244
English, Spanish
M-T 8am-5pm
Th-F 8am-5pm
S 8am - 3pm
# S6-164 Cao, Michael
NPI: 1679020622 LIC: S6-164
# 6962 Davidowitz, Rachelle
NPI: 1629594940 LIC: 6962
# 6328 Farokh, Samira
NPI: 1497091367 LIC: 6328
# S6-165 Hon, Larry
NPI: 1114378866 LIC: S6-165
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
#016519
Aces Dental
4250 Simmons Street
North Las Vegas, NV 89032
(702) 998-2237
English, Spanish, French, Hindi
M-F 9am - 5pm
# 6760 Aquino, Gabrielle
NPI: 1124482682 LIC: 6760
# 5104 Gupta, Manisha
NPI: 1255543328 LIC: 5104
# 6893 Nguyen, Hong
NPI: 1760837033 LIC: 6893
# 6670NV Nou, Cindy
NPI: 1902280654 LIC: 6670NV
# 5053 Sastry, Vilas
NPI: 1104921279 LIC: 5053
#007183
Affordable Dental
3960 W. Ann Road #120
North Las Vegas, NV 89031
(702) 399-8888
English, Korean, Russian, Spanish
M-F 9am - 5pm
# 7007NV Bowen, Douglas
NPI: 1114446564 LIC: 7007NV
# 4883 Cappiello, Aida
NPI: 1639217466 LIC: 4883
# 6902NV Chi, Hyunseok
NPI: 1124258736 LIC: 6902NV
# 3046 Chin, Harvey
NPI: 1558538090 LIC: 3046
# 4274 Chung, David
NPI: 1962505875 LIC: 4274
# 32232 Dao, Alexander
NPI: 1881148344 LIC: 32232
# 6904 Galada, Michael
NPI: 1134559636 LIC: 6904
# 6558 Goshimea, Dawit
NPI: 1821497900 LIC: 6558
# 6891 Ha, Annie
NPI: 1487095279 LIC: 6891
# 4552 Hang, John
NPI: 1033261185 LIC: 4552
# 3072 Justice, Glenn
NPI: 1790716355 LIC: 3072
# 6821 Lee, Teresa
NPI: 1659825628 LIC: 6821
# 6841 Nguyen, Jack
NPI: 1700323839 LIC: 6841
# 4751NV Pak, Minyoung
(Jonathan)
NPI: 1679776413 LIC: 4751NV
# 6637NV Phui, Andy
NPI: 1811371818 LIC: 6637NV
# 3063 Ponce, Monica
NPI: 1174598882 LIC: 3063
# 6496 Pritz, Norma
NPI: 1962825448 LIC: 6496
# 6092 Rosales, Jon-Christopher
NPI: 1144503640 LIC: 6092
# 6697 Saparam, Nischal
NPI: 1689838005 LIC: 6697
# 5737 Tiburcio, Don
NPI: 1962666719 LIC: 5737
# 3692 Ting, David
NPI: 1699887919 LIC: 3692
# 6641 Tran, Mason
NPI: 1679960611 LIC: 6641
#013512
Affordable Dental For Kids
955 W. Craig Rd Ste 106G
North Las Vegas, NV 89032
(702) 522-2272
English, Spanish
M 10am - 6pm, T 11am - 7pm
W 11am-7pm, Th 10am-6pm, F 9am-5pm
S 9am - 3pm
# 6902NV Chi, Hyunseok
NPI: 1124258736 LIC: 6902NV
# 6904 Galada, Michael
NPI: 1134559636 LIC: 6904
# 6558 Goshimea, Dawit
NPI: 1821497900 LIC: 6558
#007099
Aliante Dental
6885 Aliante Pkwy, Ste 111
North Las Vegas, NV 89084
(702) 515-1888
English, Chinese Mandarin,
Cantonese, German, Korean, Spanish,
Tagalog
M 7am - 7pm, T 7am - 5pm
W 7am-7pm, Th 7am-5pm, F 9am-5pm
S 9am - 5pm, Su 8am - 3pm
# 6902NV Chi, Hyunseok
NPI: 1124258736 LIC: 6902NV
# 4274 Chung, David
NPI: 1962505875 LIC: 4274
#006539
Allure Dental
3910 W. Ann Rd
North Las Vegas, NV 89031
(702) 737-1000
English, Chinese Mandarin, French,
Spanish, Vietnamese
M-F 9am - 6pm
# 3505 Tran, Tan
NPI: 1003977760 LIC: 3505
#006541
Avalon Dental
5465 Simmons St Ste 4
North Las Vegas, NV 89031
(702) 638-1005
Spanish, Mandarin
M-T 9am-5pm
W-Th 9am-5pm
# 4348 Hong, Randy
NPI: 1275697302 LIC: 4348
#015986
Bonita Dental
2668 N. Las Vegas Blvd, Ste 101
North Las Vegas, NV 89030
(702) 748-8244
English, Spanish, German, Panjabi,
Urdu
M-T 10am-6pm
W-Th 10am-6pm
# 6504 Jilani, Khalid
NPI: 1124431200 LIC: 6504
#017171
Children's Dentistry
1820 E. Lake Mead #G
North Las Vegas, NV 89030
(702) 903-3240
English, Spanish
M-F 9am - 5pm
# 4334 Barbin, Francesca
NPI: 1689758252 LIC: 4334
# 6866 Borghei, Sarah
NPI: 1447796636 LIC: 6866
# 6754 Campbell, Amanda
NPI: 1831504612 LIC: 6754
# 5929 Delisle, Steven
NPI: 1639329337 LIC: 5929
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 22 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
# 6752 Delisle, Nicholas
NPI: 1073963385 LIC: 6752
# 6024 Gandotra, Vivek
NPI: 1013054931 LIC: 6024
# 6831 Kim, Eugene
NPI: 1306361845 LIC: 6831
# 5606 Lebroke, Ronald
NPI: 1336310309 LIC: 5606
# 6549 Lee, Steven
NPI: 1538569389 LIC: 6549
# 6830CA Lim, Jason
NPI: 1184980955 LIC: 6830CA
# 6659 Mismas, Rachel
NPI: 1619015831 LIC: 6659
# 6841 Nguyen, Jack
NPI: 1700323839 LIC: 6841
# 6925 Patel, Payal
NPI: 1790149193 LIC: 6925
# 3080 Richens, Bradley
NPI: 1437163078 LIC: 3080
# S6-120 Salar, Behnam
NPI: 1629326400 LIC: S6-120
# 6463 Truong, Vanna
NPI: 1629400130 LIC: 6463
# 7137 Wong, Joel
NPI: 1962987602 LIC: 7137
# 2901022360 Zeitoun, Ali
NPI: 1346761368 LIC: 2901022360
#016525
Children's Dentistry of North Las
Vegas
4080 N. Mlk Blvd Ste #101B
North Las Vegas, NV 89032
(702) 903-2127
English, Spanish
M-T 8am-5pm
W 9am-5pm, Th 8am-5pm, F 9am-5pm
# 4334 Barbin, Francesca
NPI: 1689758252 LIC: 4334
# 6866 Borghei, Sarah
NPI: 1447796636 LIC: 6866
# 6754 Campbell, Amanda
NPI: 1831504612 LIC: 6754
# 5929 Delisle, Steven
NPI: 1639329337 LIC: 5929
# 6752 Delisle, Nicholas
NPI: 1073963385 LIC: 6752
# 6024 Gandotra, Vivek
NPI: 1013054931 LIC: 6024
# 6831 Kim, Eugene
NPI: 1306361845 LIC: 6831
# 5606 Lebroke, Ronald
NPI: 1336310309 LIC: 5606
# 6549 Lee, Steven
NPI: 1538569389 LIC: 6549
# 6830CA Lim, Jason
NPI: 1184980955 LIC: 6830CA
# 6659 Mismas, Rachel
NPI: 1619015831 LIC: 6659
# 6841 Nguyen, Jack
NPI: 1700323839 LIC: 6841
# 6925 Patel, Payal
NPI: 1790149193 LIC: 6925
# 3080 Richens, Bradley
NPI: 1437163078 LIC: 3080
# S6-120 Salar, Behnam
NPI: 1629326400 LIC: S6-120
# 6463 Truong, Vanna
NPI: 1629400130 LIC: 6463
# 7137 Wong, Joel
NPI: 1962987602 LIC: 7137
# 2901022360 Zeitoun, Ali
NPI: 1346761368 LIC: 2901022360
#017236
Dentistry For Families
1306 W. Craig Rd, Ste H
North Las Vegas, NV 89032
(702) 633-4333
English
M 7am - 4pm,
W 8am-5pm, Th 9am-5pm, F 7am-12pm
# 6522 Soard, Zachary
NPI: 1194131011 LIC: 6522
#007015
Desert Palms Dental
5515 Camino Al Norte, Ste 100
North Las Vegas, NV 89031
(702) 633-6332
Tagalog, Spanish, Vietnamese
M-T 9am-5pm
W-Th 9am-5pm
# 4272 Nguyen, Trinh
NPI: 1346304458 LIC: 4272
#007027
Elite Dental
6320 Simmons St, Ste 100
North Las Vegas, NV 89031
(702) 515-2508
English, Chinese Mandarin, Spanish
M-T 8am-5pm
W 9am-6pm, Th 8am-5pm, F 8am-1pm
# 4506 Trinh, Sinh
NPI: 1215995881 LIC: 4506
#016536
Happy Dental @ Craig
445 W. Craig Rd. #121-122
North Las Vegas, NV 89032
(702) 399-9118
English, Spanish, Tagalog, Vietnamese
M-T 9am-6pm
Th-F 9am-6pm
S 9am - 3pm
# 5696 Dang, Thuong
NPI: 1487606364 LIC: 5696
# 4328 Do, Thanh
NPI: 1578788139 LIC: 4328
# 4552 Hang, John
NPI: 1033261185 LIC: 4552
# 6980NV Huynh, Tram
NPI: 1053849893 LIC: 6980NV
# 6884 Lee, Andrew
NPI: 1457806499 LIC: 6884
# 5073 Nguyen, Hung
NPI: 1427124569 LIC: 5073
# 59128 Phan, Anthony
NPI: 1700976552 LIC: 59128
#007184
Hola Dental
2175 E. Cheyenne Ave #100
North Las Vegas, NV 89030
(702) 363-8889
Spanish
M-T 10am-6pm
W-Th 10am-6pm
# 6902NV Chi, Hyunseok
NPI: 1124258736 LIC: 6902NV
# 6558 Goshimea, Dawit
NPI: 1821497900 LIC: 6558
#007156
Icon Dental
1975 W. Craig Rd, Ste 103
North Las Vegas, NV 89032
(702) 220-4266
Spanish, Tagalog, Vietnamese
M-F 9am - 5pm
# 4063 Ngo, Anthony
NPI: 1093890857 LIC: 4063
#013626
Millennium Dental
3315 W. Craig Rd. Ste 108
North Las Vegas, NV 89032
(702) 202-2970
English, Farsi, German, Russian,
Spanish, Tagalog
M-T 9am-5pm
W-Th 9am-5pm
# 5998NV Rezaei, Seyed
NPI: 1568600328 LIC: 5998NV
#013472
North Las Vegas Dental Group
1703 Civic Center Dr. Ste # 6
North Las Vegas, NV 89030
(702) 649-1400
English, Spanish
T 9am - 5pm
W 9am-6pm, Th 10am-7pm, F 9am-6pm
S 9am - 2pm
# 6558 Goshimea, Dawit
NPI: 1821497900 LIC: 6558
# 4837 Nguyen, Thong
NPI: 1427183953 LIC: 4837
# NV4555 Trinh, Thomas
NPI: 1225202849 LIC: NV4555
#020499
Risas Dental & Braces
2500 E. Lake Mead
North Las Vegas, NV 89030
(702) 649-2782
English, Spanish
M-F 9am - 8pm
# 51777 Fellars, David
NPI: 1659555076 LIC: 51777
# 7124NV Hess, Trevor
NPI: 1831507482 LIC: 7124NV
# 4920 Menlove, Benjamin
NPI: 1487710174 LIC: 4920
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 23 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
#016982
Smile Reef Pediatric Dentistry
3870 W. Ann Rd. Ste #120
North Las Vegas, NV 89031
(702) 570-7333
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# S6-100 Jensen, Jaren
NPI: 1225207251 LIC: S6-100
# S6-126C Lamb, Christopher
NPI: 1154558815 LIC: S6-126C
# S6-160 Vaughn, Andrew
NPI: 1568692242 LIC: S6-160
#014524
Vista Dental
3960 W. Craig Rd. Ste 110
North Las Vegas, NV 89032
(702) 464-3000
English, Spanish, Vietnamese
M-T 9am-6pm
W 9am-2pm, Th 9pm-6pm, F 9am-6pm
# 6463NV Truong, Nhan (Ben)
NPI: 1013940915 LIC: 6463NV
PAHRUMP
#016836
Affordable Family Dental
270 S. Dahlia St. Ste 4
Pahrump, NV 89048
(775) 727-8848
English, Spanish
M-Th 9am - 5pm
# 6069NV Yim, Sean
NPI: 1568779486 LIC: 6069NV
#010293
American Dental
150 S. Hwy 160, Ste C11
Pahrump, NV 89048
(775) 727-8818
Vietnamese, English, Spanish
M-F 9am - 6pm
# 5073 Nguyen, Hung
NPI: 1427124569 LIC: 5073
#016526
Children's Dentistry of Pahrump
1017 E. Basin Ave Ste #1
Pahrump, NV 89060
(775) 419-6604
English, Spanish
M-F 9am - 5pm
# 6866 Borghei, Sarah
NPI: 1447796636 LIC: 6866
# 6754 Campbell, Amanda
NPI: 1831504612 LIC: 6754
# 5929 Delisle, Steven
NPI: 1639329337 LIC: 5929
# 6752 Delisle, Nicholas
NPI: 1073963385 LIC: 6752
# 6024 Gandotra, Vivek
NPI: 1013054931 LIC: 6024
# 6831 Kim, Eugene
NPI: 1306361845 LIC: 6831
# 5606 Lebroke, Ronald
NPI: 1336310309 LIC: 5606
# 6549 Lee, Steven
NPI: 1538569389 LIC: 6549
# 6830CA Lim, Jason
NPI: 1184980955 LIC: 6830CA
# 6659 Mismas, Rachel
NPI: 1619015831 LIC: 6659
# 6841 Nguyen, Jack
NPI: 1700323839 LIC: 6841
# 6925 Patel, Payal
NPI: 1790149193 LIC: 6925
# 3080 Richens, Bradley
NPI: 1437163078 LIC: 3080
# S6-120 Salar, Behnam
NPI: 1629326400 LIC: S6-120
# 6463 Truong, Vanna
NPI: 1629400130 LIC: 6463
#016527
Sedation Dental Center of
Pahrump
1420 E. Hwy 372
Pahrump, NV 89048
(775) 727-6647
English, Spanish
M-T 8am-4pm
Th-F 8am-4pm
# 6866 Borghei, Sarah
NPI: 1447796636 LIC: 6866
# 6754 Campbell, Amanda
NPI: 1831504612 LIC: 6754
# 5929 Delisle, Steven
NPI: 1639329337 LIC: 5929
# 6752 Delisle, Nicholas
NPI: 1073963385 LIC: 6752
# 6024 Gandotra, Vivek
NPI: 1013054931 LIC: 6024
# 6831 Kim, Eugene
NPI: 1306361845 LIC: 6831
# 5606 Lebroke, Ronald
NPI: 1336310309 LIC: 5606
# 6549 Lee, Steven
NPI: 1538569389 LIC: 6549
# 6830CA Lim, Jason
NPI: 1184980955 LIC: 6830CA
# 6659 Mismas, Rachel
NPI: 1619015831 LIC: 6659
# 6841 Nguyen, Jack
NPI: 1700323839 LIC: 6841
# 6925 Patel, Payal
NPI: 1790149193 LIC: 6925
# 3080 Richens, Bradley
NPI: 1437163078 LIC: 3080
# S6-120 Salar, Behnam
NPI: 1629326400 LIC: S6-120
RENO
#016684
Absolute Dental & Orthodontics
901 W. 4Th St, Ste B
Reno, NV 89503
(775) 322-0800
English, Spanish
M-F 8am - 5pm
# 6808NV Abittan, Aimee
NPI: 1336599125 LIC: 6808NV
# 6855 Albander, Lina
NPI: 1326599275 LIC: 6855
# 6656OK Alford, Jacqueline
NPI: 1275935702 LIC: 6656OK
# 31436 Browne, Morgan
NPI: 1316316706 LIC: 31436
# 7158 Carpenter, Clifton
NPI: 1548613185 LIC: 7158
# 6874NV Futch, Scott
NPI: 1003987744 LIC: 6874NV
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# 6803 Nygren, Amy
NPI: 1447794854 LIC: 6803
# 62428 Pham, Jeremy
NPI: 1679912281 LIC: 62428
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
# 6163NV Silvaroli, Patrick
NPI: 1699096701 LIC: 6163NV
# 7095NV Vial, Nicolette
NPI: 1679069645 LIC: 7095NV
# 5893 Vu, Trung
NPI: 1548474760 LIC: 5893
#016687
Absolute Dental & Orthodontics
5032 S. Virginia St
Reno, NV 89502
(775) 787-8900
English, Spanish
M-F 8am - 5pm
# 6808NV Abittan, Aimee
NPI: 1336599125 LIC: 6808NV
# 6855 Albander, Lina
NPI: 1326599275 LIC: 6855
# 6656OK Alford, Jacqueline
NPI: 1275935702 LIC: 6656OK
# 31436 Browne, Morgan
NPI: 1316316706 LIC: 31436
# 7158 Carpenter, Clifton
NPI: 1548613185 LIC: 7158
# 6874NV Futch, Scott
NPI: 1003987744 LIC: 6874NV
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# 6803 Nygren, Amy
NPI: 1447794854 LIC: 6803
# 62428 Pham, Jeremy
NPI: 1679912281 LIC: 62428
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
# 6163NV Silvaroli, Patrick
NPI: 1699096701 LIC: 6163NV
# 7095NV Vial, Nicolette
NPI: 1679069645 LIC: 7095NV
# 5893 Vu, Trung
NPI: 1548474760 LIC: 5893
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 24 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
#FQHC007201
Community Health Alliance
1055 S. Wells Ave, Ste 120
Reno, NV 89502
(775) 329-6300
Spanish
M-F 6am - 6pm
# 6121 Clausen, Jessica
NPI: 1811298805 LIC: 6121
# 6500 Collier, Lisa
NPI: 1619281052 LIC: 6500
# 5555 Dupont, Brandi
NPI: 1841489432 LIC: 5555
# 6203NV Fillmore, Alec
NPI: 1437416013 LIC: 6203NV
# 6668 Montoya, Natalia
NPI: 1417330770 LIC: 6668
#FQHC016576
Community Health Alliance -
Outreach Dental
335 Record St Ste 254
Reno, NV 89512
(775) 324-2599
Spanish
T 7am - 4pm
W-F 7am-5pm
S 7am - 5pm
# 6216NV Ahmadian, Moni
NPI: 1790033553 LIC: 6216NV
# 6121 Clausen, Jessica
NPI: 1811298805 LIC: 6121
# 6500 Collier, Lisa
NPI: 1619281052 LIC: 6500
# 5555 Dupont, Brandi
NPI: 1841489432 LIC: 5555
# 6203NV Fillmore, Alec
NPI: 1437416013 LIC: 6203NV
# 6668 Montoya, Natalia
NPI: 1417330770 LIC: 6668
#007149
Courtesy Dental & Orthodontics -
Reno
748 S Meadows Pkwy Ste 8
Reno, NV 89521
(775) 851-9099
Spanish
M 10am - 6pm, T 8am - 4pm
W-F 8am-4pm
# 6740 Atwal, Parminder
NPI: 1174938039 LIC: 6740
# 6336 Basta, Trevor
NPI: 1962753996 LIC: 6336
# 6675NV Dapra Jr., David
NPI: 1447633474 LIC: 6675NV
# 6368 Hashtroudi, Saman
NPI: 1740520188 LIC: 6368
# 6467 Myrin, Christina
NPI: 1881025476 LIC: 6467
#016645
Just Smiles Dental Care
McGruder, P.C.
2900 Clear Acre Ln Ste S
Reno, NV 89512
(775) 337-6453
English, Korean, Spanish
M-F 8am - 5pm
# 5870 Mcgruder, Keith
NPI: 1801983887 LIC: 5870
#010696
Kid Dental, LLC
1101 W. Moana Ln, Ste #4
Reno, NV 89509
(775) 825-5005
English, Spanish
M-F 8am - 5pm
# 6326NV Brooks, Benita
NPI: 1366794018 LIC: 6326NV
# 4833 Delappe, Roy
NPI: 1104927383 LIC: 4833
# 6683 Dinh, Megan-Vinh
NPI: 1225408701 LIC: 6683
# S6-156 Gray, Hans
NPI: 1811336753 LIC: S6-156
# 6375 Lee, Hyuni
NPI: 1134553977 LIC: 6375
# 4187 Rosenberg, Mark
NPI: 1871507582 LIC: 4187
# 6681 Todd, Chelsie
NPI: 1376926980 LIC: 6681
#016649
My Kid's Smile
10645 Double R Blvd
Reno, NV 89521
(775) 852-6164
English, Spanish
M-T 8am-5pm
Th-F 8am-5pm
# 7020 Bui-Fong, Nicole
NPI: 1912438334 LIC: 7020
# S6-149 Gookin, Trent
NPI: 1477971026 LIC: S6-149
# 6376NV Horgan, Bryan
NPI: 1235487745 LIC: 6376NV
# 4489NV Teglia, Cintia
NPI: 1578628798 LIC: 4489NV
# S6-141 Whipple, Emily
NPI: 1851549810 LIC: S6-141
# S6-117 Wilde, Blake
NPI: 1366706087 LIC: S6-117
#016651
My Kid's Smile
5030 Las Brisas Ste. B-3
Reno, NV 89523
(775) 852-6164
Spanish, English
M 7am - 5pm, T 8am - 5pm
W-F 8am-5pm
# 7020 Bui-Fong, Nicole
NPI: 1912438334 LIC: 7020
# 6376NV Horgan, Bryan
NPI: 1235487745 LIC: 6376NV
# 4489NV Teglia, Cintia
NPI: 1578628798 LIC: 4489NV
#016652
My Kid's Smile
1130 N. Hills Blvd. Ste. 101
Reno, NV 89506
(775) 409-4604
English, Spanish
M-F 8am - 5pm
# 7020 Bui-Fong, Nicole
NPI: 1912438334 LIC: 7020
# S6-149 Gookin, Trent
NPI: 1477971026 LIC: S6-149
# 6376NV Horgan, Bryan
NPI: 1235487745 LIC: 6376NV
# 4489NV Teglia, Cintia
NPI: 1578628798 LIC: 4489NV
# S6-141 Whipple, Emily
NPI: 1851549810 LIC: S6-141
# S6-117 Wilde, Blake
NPI: 1366706087 LIC: S6-117
#021473
Sierra Kids Dentistry
1141 Steamboat Parkway, Ste 900
Reno, NV 89521
(775) 357-9515
English, Spanish
M-T 8am-5pm
Th-F 8am-5pm
# S6-156 Gray, Hans
NPI: 1811336753 LIC: S6-156
#016738
Small Smiles of Reno
3362 S. Mccarran Blvd
Reno, NV 89502
(775) 329-5437
Spanish
M-T 8am-5pm
W-Th 8am-5pm
# 6362 Collins, Lindsey
NPI: 1952641243 LIC: 6362
# 6715 Graber, Raymond
NPI: 1649660622 LIC: 6715
# 5169 Mann, James
NPI: 1346330479 LIC: 5169
# 6827 Mclennan, Ryann
NPI: 1235682071 LIC: 6827
# 6708 Mellor, Christy
NPI: 1477833440 LIC: 6708
# 6269 Redlinger, Teala
NPI: 1588984389 LIC: 6269
# S6-141 Whipple, Emily
NPI: 1851549810 LIC: S6-141
#019665
Toothfairy Pediatric Dental
75 Mount Rose St. Ste A
Reno, NV 89509
(775) 971-4252
English, Farsi, Spanish
M-F 8am - 5pm
# 0767 Davies, Michael
NPI: 1649347519 LIC: 0767
# 6683 Dinh, Megan-Vinh
NPI: 1225408701 LIC: 6683
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 25 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
# 6382 Jensen, James
NPI: 1134568876 LIC: 6382
# S6-120 Salar, Behnam
NPI: 1629326400 LIC: S6-120
# 6463 Truong, Vanna
NPI: 1629400130 LIC: 6463
# 5622 Vu, John
NPI: 1801087838 LIC: 5622
#008915
Western Dental - Reno
8040 S. Virginia St, Ste 1
Reno, NV 89511
(775) 852-8683
English, Spanish
M-T 9am-6pm
W-Th 9am-6pm
# 0823 Martin, Marty
NPI: 1083892863 LIC: 0823
SAINT GEORGE
#016956
Children's Dental of Southern
Utah
2746 E. 850 N
Saint George, UT 84790
(435) 673-7776
English, Spanish
M-T 6am-6pm
W-Th 6am-6pm
# 6329558-9923 Scholzen, Jeremy
NPI: 1063596104 LIC: 6329558-9923
# 8560597-9923 Spencer, Brandon
NPI: 1538137534 LIC: 8560597-9923
#017260
Dixie Pediatric Dental
368 E. Riverside Drive, Ste 6
Saint George, UT 84790
(435) 688-8827
English
M-T 8am-5pm
W-Th 8am-5pm
# 5336153-9923 Christensen, Brett
NPI: 1073627295 LIC: 5336153-9923
SALT LAKE CITY
#016790
Salt Lake Pediatric Dentistry
1548 E. 4500 South, Ste 102
Salt Lake City, UT 84117
(801) 463-1900
English, Spanish
M-F 8am - 5pm
# 7348465-9923 Gustafson, David
NPI: 1871783027 LIC: 7348465-9923
# 6273877-9922 Rupp, Jeffery
NPI: 1720149453 LIC: 6273877-9922
SPARKS
#016686
Absolute Dental & Orthodontics
5015 Pyramid Way Ste 113
Sparks, NV 89436
(775) 424-3000
English, Spanish
M-T 8am-5pm
Th-F 8am-3pm
S 9am - 1pm
# 6808NV Abittan, Aimee
NPI: 1336599125 LIC: 6808NV
# 6855 Albander, Lina
NPI: 1326599275 LIC: 6855
# 6656OK Alford, Jacqueline
NPI: 1275935702 LIC: 6656OK
# 31436 Browne, Morgan
NPI: 1316316706 LIC: 31436
# 7158 Carpenter, Clifton
NPI: 1548613185 LIC: 7158
# 6874NV Futch, Scott
NPI: 1003987744 LIC: 6874NV
# 4951 Mir, Joseph
NPI: 1588746770 LIC: 4951
# 6803 Nygren, Amy
NPI: 1447794854 LIC: 6803
# 62428 Pham, Jeremy
NPI: 1679912281 LIC: 62428
# S6-33C Prada, Patricia
NPI: 1649360306 LIC: S6-33C
# 6163NV Silvaroli, Patrick
NPI: 1699096701 LIC: 6163NV
# 5893 Vu, Trung
NPI: 1548474760 LIC: 5893
#FQHC016579
Community Health Alliance -
Sparks Health Center
2244 Oddie Blvd
Sparks, NV 89431
(775) 997-7300
M-F 7am - 6pm
# 6121 Clausen, Jessica
NPI: 1811298805 LIC: 6121
# 6500 Collier, Lisa
NPI: 1619281052 LIC: 6500
# 5555 Dupont, Brandi
NPI: 1841489432 LIC: 5555
# 6203NV Fillmore, Alec
NPI: 1437416013 LIC: 6203NV
# 6668 Montoya, Natalia
NPI: 1417330770 LIC: 6668
#007108
Courtesy Dental & Orthodontics -
Sparks
840 I Street, Ste 3
Sparks, NV 89431
(775) 358-1870
Spanish
M 10am - 6pm, T 8am - 4pm
W-F 8am-4pm
# 6740 Atwal, Parminder
NPI: 1174938039 LIC: 6740
# 6336 Basta, Trevor
NPI: 1962753996 LIC: 6336
# 6675NV Dapra Jr., David
NPI: 1447633474 LIC: 6675NV
# 6368 Hashtroudi, Saman
NPI: 1740520188 LIC: 6368
# 6467 Myrin, Christina
NPI: 1881025476 LIC: 6467
#016570
Dentistry For Children
850 I St
Sparks, NV 89431
(775) 358-5330
English, Spanish, Mandarin, Tagalog
M 8am - 5pm,
W-F 8am-5pm
# S6-83 Chan, Joseph
NPI: 1669511887 LIC: S6-83
# 6030 Michael, Mary Ann
NPI: 1609039072 LIC: 6030
#016720
Kid Dental LLC
1301 N. Mccarran Blvd Ste 104
Sparks, NV 89431
(775) 470-5070
Spanish
M-F 8am - 5pm
# 6326NV Brooks, Benita
NPI: 1366794018 LIC: 6326NV
# 4833 Delappe, Roy
NPI: 1104927383 LIC: 4833
# 6683 Dinh, Megan-Vinh
NPI: 1225408701 LIC: 6683
# S6-156 Gray, Hans
NPI: 1811336753 LIC: S6-156
# 6375 Lee, Hyuni
NPI: 1134553977 LIC: 6375
# 4187 Rosenberg, Mark
NPI: 1871507582 LIC: 4187
# 6681 Todd, Chelsie
NPI: 1376926980 LIC: 6681
#016650
My Kid's Smile
3150 Vista Blvd. Ste 112
Sparks, NV 89436
(775) 852-6164
English, Spanish
M-F 8am - 5pm
# 7020 Bui-Fong, Nicole
NPI: 1912438334 LIC: 7020
# S6-149 Gookin, Trent
NPI: 1477971026 LIC: S6-149
# 6376NV Horgan, Bryan
NPI: 1235487745 LIC: 6376NV
# 4489NV Teglia, Cintia
NPI: 1578628798 LIC: 4489NV
# S6-141 Whipple, Emily
NPI: 1851549810 LIC: S6-141
# S6-117 Wilde, Blake
NPI: 1366706087 LIC: S6-117
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 26 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
#014467
Toothfairy Pediatric Dental
2261 Pyramid Way, Ste 2
Sparks, NV 89431
(775) 971-4252
English, Spanish
M-F 8am - 5pm
# 6865 Cope, Austin
NPI: 1063893659 LIC: 6865
# 0767 Davies, Michael
NPI: 1649347519 LIC: 0767
# 6683 Dinh, Megan-Vinh
NPI: 1225408701 LIC: 6683
# 6376NV Horgan, Bryan
NPI: 1235487745 LIC: 6376NV
# 6382 Jensen, James
NPI: 1134568876 LIC: 6382
# S6-120 Salar, Behnam
NPI: 1629326400 LIC: S6-120
# 6463 Truong, Vanna
NPI: 1629400130 LIC: 6463
#016661
Wayne G. Terhune, D.D.S.
2261 Pyramid Way Sutie 1
Sparks, NV 89431
(775) 331-4464
English
T 9am - 5pm
W-Th 11am-5pm
# 1034 Terhune, Wayne
NPI: 1467663658 LIC: 1034
#009285
Western Dental- Sparks
685 E. Prater Way, Ste 103
Sparks, NV 89431
(775) 358-4601
Spanish
M-T 9am-6pm
W 8am-5pm, Th 9am-6pm, F 8am-5pm
# 0823 Martin, Marty
NPI: 1083892863 LIC: 0823
#016900
Wildcreek Dental
4650 Wedekind Rd Ste 1
Sparks, NV 89431
(775) 356-8254
English, Spanish
T 8am - 5pm
W-Th 8am-5pm
# 6865 Cope, Austin
NPI: 1063893659 LIC: 6865
SUN VALLEY
#018716
Toothfairy Dental
5055 Sun Valley Blvd Ste 350
Sun Valley, NV 89433
(775) 971-4252
English, Spanish
M-F 8am - 5pm
# 0767 Davies, Michael
NPI: 1649347519 LIC: 0767
# 6683 Dinh, Megan-Vinh
NPI: 1225408701 LIC: 6683
# 6376NV Horgan, Bryan
NPI: 1235487745 LIC: 6376NV
# 6382 Jensen, James
NPI: 1134568876 LIC: 6382
# S6-120 Salar, Behnam
NPI: 1629326400 LIC: S6-120
# 6463 Truong, Vanna
NPI: 1629400130 LIC: 6463
TOOELE
#016788
Burg Children's Dentistry &
Orthodontics - Stansbury Park
220 Millpond Drive, Ste 107
Tooele, UT 84074
(435) 843-5437
English, Spanish
M-T 8am-4pm
W-Th 8am-4pm
# 10193170-9923 Bunker, Adam
NPI: 1215193792 LIC: 10193170-9923
# 6656202-9922 Knudson, Darin
NPI: 1396942850 LIC: 6656202-9922
# 8311374-9922 Linford, Daniel
NPI: 1013228709 LIC: 8311374-9922
# 7919772-9922 Nielson, Robert
NPI: 1821381666 LIC: 7919772-9922
# 9474332-9922 Nordfelt, Jed
NPI: 1871888735 LIC: 9474332-9922
# 7108173-9923 Segura, Stuart
NPI: 1255589164 LIC: 7108173-9923
# 143612-9922 Thomas, Stuart
NPI: 1508826272 LIC: 143612-9922
TWIN FALLS
#016838
Smiles 4 Kids
1411 Falls Ave E Ste 1000C
Twin Falls, ID 83301
(208) 734-7415
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# D-4569-PD Jenkins, Joshua
NPI: 1659682912 LIC: D-4569-PD
# D-4745 Johnson, Paul
NPI: 1871848598 LIC: D-4745
# D-4496-PD Nielson, Ryan
NPI: 1558709527 LIC: D-4496-PD
# D-4031 Palmer, Zane
NPI: 1619992112 LIC: D-4031
# D-4217-PD Pryor, Trent
NPI: 1780813691 LIC: D-4217-PD
# D-4351-PD Smith, Trevor
NPI: 1235392770 LIC: D-4351-PD
WENDOVER
#016994
Wendover Dental Care
399 N. Aria Blvd
Wendover, UT 84083
(435) 665-2962
English, Spanish
M 11am - 3pm, T 9am - 6pm
W 9am-5am, Th 9am-5pm, F 11am-3pm
# 6945665-9923 Devries, Bradley
NPI: 1568624690 LIC: 6945665-9923
# 324928-9923 Hill, Jared
NPI: 1205884657 LIC: 324928-9923
WEST JORDAN
#021613
James E. Russon DDS PC
5899 W. Rivendell Drive
West Jordan, UT 84081
(801) 294-5781
English
T 10am - 1pm
# 1382169922 Russon, James
NPI: 1780885947 LIC: 1382169922
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 27 of 28
3rd Quarter, 2019
General Dentists / Dentistas Generales - NEVADA MEDICAID CHILD & NEVADA CHECK UP
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Member Services / Servicios para miembros: (866) 609-0418
Availability of Language Assistance Services
LIBERTY makes certain language assistance services available to you at no cost. If English is not your preferred language and you need
help communicating in your preferred language, you may call 866-609-0418 to ask what language services are available to you.
Enrollees with Disabilities
As a LIBERTY enrollee (including enrollees with disabilities), you have full and equal access to covered services as required under the federal
Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973.
Directory Information
Did you find information that you think may need to be updated in our provider directories? Please let us know, so we can review it.
Phone: (866) 609-0418 Email: providerdirectories@libertydentalplan.com
The provider directory is subject to change without notice.
Languages spoken by the offices are self-reported and are not independently verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/nvmedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas han sido
auto-reportados y no han sido verificados de manera independiente por LIBERTY Dental Plan. Si necesita usar los servicios
gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/nvmedicaid.
/ trimestre de 2019
* Closed to new members / Cerrado para nuevos miembros. Wheelchair access / Acceso para personas en silla de ruedas.
Page 28 of 28
3rd Quarter, 2019
