Healthcare Provider Details

I. General information

NPI: 1942929898
Provider Name (Legal Business Name): ENHANCED COSMETIC AND IMPLANT DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E WARM SPRINGS RD STE 100
LAS VEGAS NV
89119-4283
US

IV. Provider business mailing address

2840 E FLAMINGO RD STE G
LAS VEGAS NV
89121-5202
US

V. Phone/Fax

Practice location:
  • Phone: 725-765-9500
  • Fax: 702-541-9849
Mailing address:
  • Phone: 702-224-2762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER GARDEL
Title or Position: INSURANCE MANAGER
Credential:
Phone: 702-224-2762