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General NPI Number Information
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NPI Number | 1760145916
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Entity Type | Organization
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Legal Business Name | ADA NEVADA DENTAL LLC
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Dates
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Enumeration Date | 10/14/2021
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Last Update Date | 10/14/2021
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Provider Practice Location Address
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Address Line | 5001 E BONANZA RD STE 160
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City | LAS VEGAS
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State | NV
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Zip | 89110-3560
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Country | US
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Telephone | 702-307-2273
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Fax | 702-307-2275
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Provider Business Mailing Address
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Address Line | 5001 E BONANZA RD STE 160
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City | LAS VEGAS
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State | NV
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Zip | 89110-3560
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Country | US
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Telephone | 702-307-2273
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Fax | 702-307-2275
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. GREGORY WALTER GREENWOOD
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Credential | DMD, PHARMD, MACSD
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Telephone | 504-952-0344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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