Healthcare Provider Details

I. General information

NPI: 1730817487
Provider Name (Legal Business Name): HANSEN MILLER WHETTEN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7445 W AZURE DR STE 120
LAS VEGAS NV
89130-4429
US

IV. Provider business mailing address

7445 W AZURE DR STE 120
LAS VEGAS NV
89130-4429
US

V. Phone/Fax

Practice location:
  • Phone: 702-757-4693
  • Fax:
Mailing address:
  • Phone: 702-757-4693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LESLIE TERRY
Title or Position: FINANCIAL COORDINATOR
Credential:
Phone: 702-236-9676