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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1720327208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P3 DENTAL - WELEBIR PC

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

Provider Business Practice Location Address
First Line	:	8965 S. EASTERN AVENUE, SUITE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123
Country	:	US
Telephone Number	:	702-387-6453
Fax Number	:	702-617-6019

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

Provider Enumeration Date	:	02/04/2013
Last Update Date	:	04/10/2019

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