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General NPI Number Information
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NPI Number | 1962223784
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Entity Type | Organization
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Legal Business Name | MW DENTAL PROF. LLC
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 10010 W CHEYENNE AVE STE 140
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City | LAS VEGAS
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State | NV
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Zip | 89129-7714
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Country | US
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Telephone | 702-227-4392
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Fax | 702-636-1688
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Provider Business Mailing Address
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Address Line | 6825 ANTLER CT
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City | LAS VEGAS
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State | NV
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Zip | 89149-9602
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Country | US
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Telephone | 702-860-5829
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Fax | 702-636-1688
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MICHAEL RAY WENDELBOE
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Credential | DMD
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Telephone | 702-860-5829
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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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