MEDICARE: GEORGE A TANKSLEY JR DMD A PROFESSINAL CORPORATION

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	1223G0001X	General Practice Dentistry	4619	NV

General Provider Information

NPI Number	:	1376609305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE A TANKSLEY JR DMD A PROFESSINAL CORPORATION

Provider Business Mailing Address
First Line	:	4250 S RAINBOW BLVD
Second Line	:	SUITE 1004
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3159
Country	:	US
Telephone Number	:	702-364-9700
Fax Number	:	702-364-9943

Provider Business Practice Location Address
First Line	:	4250 S RAINBOW BLVD
Second Line	:	SUITE 1004
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3159
Country	:	US
Telephone Number	:	702-364-9700
Fax Number	:	702-364-9943

Authorized Official
Title or Position	:	DOCTOR OWNER
Name	:	DR. GEORGE ARTHUR TANKSLEY JR.
Credential	:	DMD
Telephone Number	:	702-364-9700

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	08/22/2020

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