Healthcare Provider Details

I. General information

NPI: 1609701358
Provider Name (Legal Business Name): JR DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 E LAKE MEAD PKWY
HENDERSON NV
89015-6440
US

IV. Provider business mailing address

256 E LAKE MEAD PKWY
HENDERSON NV
89015-6440
US

V. Phone/Fax

Practice location:
  • Phone: 702-703-5410
  • Fax:
Mailing address:
  • Phone: 702-703-5410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: AMY GARFIELD
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 435-452-1315