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General NPI Number Information
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NPI Number | 1952192015
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Entity Type | Organization
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Legal Business Name | DENTAL IMPLANT SPECIALISTS OF NEVADA - WILLARDSEN, PC
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Dates
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Enumeration Date | 05/16/2025
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 9061 W POST RD
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City | LAS VEGAS
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State | NV
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Zip | 89148-2411
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Country | US
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Telephone | 702-434-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 3500 MAPLE AVE STE 1150
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City | DALLAS
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State | TX
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Zip | 75219-3949
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROVIDER PARTNER
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Name | JAMES WILLARDSEN
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Credential |
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Telephone | 702-481-0089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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