MEDICARE: DENTISTING, 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1558527978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTISTING, LLC

Provider Business Mailing Address
First Line	:	2101 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-3175
Country	:	US
Telephone Number	:	702-522-2269
Fax Number	:	702-990-8856

Provider Business Practice Location Address
First Line	:	5075 E BONANZA RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110
Country	:	US
Telephone Number	:	702-871-8888
Fax Number	:	702-871-8889

Authorized Official
Title or Position	:	INSURANCE DEPT MANAGER
Name	:	ROLAND PISCHINGER
Credential	:
Telephone Number	:	702-522-2028

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	05/31/2018

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Directions to “DENTISTING, LLC ” Practice Location

Language	Start Address	Practice Location

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