Healthcare Provider Details

I. General information

NPI: 1245371392
Provider Name (Legal Business Name): WAYNE ADAM DUNETZ D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: WAYNE ADAM DUNETZ P.A.-C

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 E WASHINGTON AVE
LAS VEGAS NV
89110-5783
US

IV. Provider business mailing address

PO BOX 31327
LAS VEGAS NV
89173-1327
US

V. Phone/Fax

Practice location:
  • Phone: 702-821-6763
  • Fax: 702-684-6015
Mailing address:
  • Phone: 702-821-6763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number9904
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA637
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number9904
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: