Healthcare Provider Details

I. General information

NPI: 1649358300
Provider Name (Legal Business Name): ALBERT THEODORE TWESME D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: A. TED TWESME D.D.S.

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4544 S PECOS RD
LAS VEGAS NV
89121-5923
US

IV. Provider business mailing address

4544 S PECOS RD
LAS VEGAS NV
89121-5923
US

V. Phone/Fax

Practice location:
  • Phone: 702-436-0900
  • Fax: 702-436-0636
Mailing address:
  • Phone: 702-436-0900
  • Fax: 702-436-0636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberS2-48
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: