MEDICARE: NEVADA DENTURE SERVICE

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	550	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912119660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA DENTURE SERVICE

Provider Business Mailing Address
First Line	:	2605 S DECATUR BLVD
Second Line	:	SUITE 116
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8591
Country	:	US
Telephone Number	:	702-878-1737
Fax Number	:	702-259-9634

Provider Business Practice Location Address
First Line	:	2605 S DECATUR BLVD
Second Line	:	SUITE 116
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8591
Country	:	US
Telephone Number	:	702-878-1737
Fax Number	:	702-259-9634

Authorized Official
Title or Position	:	OWNER
Name	:	MS. LAUNA S MEANS
Credential	:
Telephone Number	:	702-878-1737

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	08/13/2008

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Directions to “NEVADA DENTURE SERVICE ” Practice Location

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