Healthcare Provider Details

I. General information

NPI: 1780305680
Provider Name (Legal Business Name): WOW DENTAL ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10830 W CHARLESTON BLVD
LAS VEGAS NV
89135-1193
US

IV. Provider business mailing address

2028 GLENVIEW DR
LAS VEGAS NV
89134-6114
US

V. Phone/Fax

Practice location:
  • Phone: 702-268-7132
  • Fax: 725-201-0469
Mailing address:
  • Phone: 702-268-7132
  • Fax: 725-201-0469

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: CHUN-YU YOGI CHEN
Title or Position: CHAIRMAN
Credential: DMD
Phone: 702-268-7132