MEDICARE: TRENT E. TOBLER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1205478732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRENT E. TOBLER, LLC

Provider Business Mailing Address
First Line	:	6121 W LAKE MEAD BLVD STE 115
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2737
Country	:	US
Telephone Number	:	402-505-6843
Fax Number	:

Provider Business Practice Location Address
First Line	:	5890 S DURANGO DR STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2319
Country	:	US
Telephone Number	:	402-505-6843
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	RIKKI LIEBERTH
Credential	:
Telephone Number	:	402-505-6843

Provider Enumeration Date	:	10/16/2019
Last Update Date	:	08/12/2022

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