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General NPI Number Information
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NPI Number | 1922569607
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Entity Type | Organization
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Legal Business Name | 4G DENTAL PARTNERS
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Dates
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Enumeration Date | 03/26/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 4235 E CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89104-2380
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Country | US
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Telephone | 702-456-0005
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Fax | 702-920-8892
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Provider Business Mailing Address
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Address Line | 4750 W SAHARA AVE STE 12
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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 | 702-381-7059
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Fax | 702-979-5864
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Authorized Official
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Title or Position | OWNER
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Name | DR. WYATT STOTT 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 |
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License Number State |
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