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General NPI Number Information
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NPI Number | 1457703290
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Entity Type | Individual
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Provider Name | WESLEY ARCHER D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2016
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 10400 S EASTERN AVE
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City | HENDERSON
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State | NV
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Zip | 89052-3957
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Country | US
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Telephone | 702-531-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 12212 CAPILLA REAL AVE
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City | LAS VEGAS
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State | NV
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Zip | 89138-4543
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Country | US
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Telephone | 702-528-7015
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D11915
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | S6-166
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License Number State | NV
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