Healthcare Provider Details

I. General information

NPI: 1962969626
Provider Name (Legal Business Name): NV DENTAL PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 N STEPHANIE ST STE 211
HENDERSON NV
89014-8773
US

IV. Provider business mailing address

375 N STEPHANIE ST STE 211
HENDERSON NV
89014-8773
US

V. Phone/Fax

Practice location:
  • Phone: 702-454-1008
  • Fax: 702-454-1009
Mailing address:
  • Phone: 702-454-1008
  • Fax: 702-454-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW WIRIG
Title or Position: MANAGER
Credential: DMD
Phone: 702-454-1008