Healthcare Provider Details

I. General information

NPI: 1821482423
Provider Name (Legal Business Name): WEBBERSON DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 W CHEYENNE AVE STE 108
LAS VEGAS NV
89129-8412
US

IV. Provider business mailing address

7730 W CHEYENNE AVE STE 108
LAS VEGAS NV
89129-8412
US

V. Phone/Fax

Practice location:
  • Phone: 702-658-8008
  • Fax: 702-778-2962
Mailing address:
  • Phone: 702-658-8008
  • Fax: 702-778-2962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4342
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEPHANI THERESA BATEMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 702-658-8008