MEDICARE: P3 DENTAL - WELEBIR PC

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	:	1578885521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P3 DENTAL - WELEBIR PC

Provider Business Mailing Address
First Line	:	P3 DENTAL - WELEBIR PC
Second Line	:	1131 S. CASINO BLVD
City	:	LAS VEGAS
State	:	NV
Zip	:	89104
Country	:	US
Telephone Number	:	702-648-2094
Fax Number	:	702-648-0875

Provider Business Practice Location Address
First Line	:	4358 WEST CHEYENNE AVENUE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032
Country	:	US
Telephone Number	:	702-735-9500
Fax Number	:	702-586-1592

Authorized Official
Title or Position	:	SUPERVISOR
Name	:	BEATRIZ HERNANDEZ
Credential	:
Telephone Number	:	714-578-6591

Provider Enumeration Date	:	02/18/2010
Last Update Date	:	11/01/2018

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