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General NPI Number Information
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NPI Number | 1770072274
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Entity Type | Organization
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Legal Business Name | SAHARA DENTAL PARTNERS LLC
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Dates
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Enumeration Date | 05/09/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 4750 W SAHARA AVE STE 11
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City | LAS VEGAS
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State | NV
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Zip | 89102-3559
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Country | US
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Telephone | 702-456-0005
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Fax |
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Provider Business Mailing Address
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Address Line | 556 N EASTERN AVE STE I
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City | LAS VEGAS
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State | NV
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Zip | 89101-3453
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Country | US
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Telephone | 702-960-4484
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Fax | 702-987-3040
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Authorized Official
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Title or Position | OWNER
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Name | WYATT DANNELS
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Credential | DDS
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Telephone | 702-456-0005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 6743
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License Number State | NV
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