MEDICARE: FLAMINGO DENTAL PARTNERS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1083233001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLAMINGO DENTAL PARTNERS LLC

Provider Business Mailing Address
First Line	:	6680 W FLAMINGO RD STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-2189
Country	:	US
Telephone Number	:	702-389-4039
Fax Number	:	702-389-1887

Provider Business Practice Location Address
First Line	:	6680 W FLAMINGO RD STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-2189
Country	:	US
Telephone Number	:	702-389-4039
Fax Number	:	702-389-1887

Authorized Official
Title or Position	:	OWNER
Name	:	WYATT S DANNELS
Credential	:	DDS
Telephone Number	:	702-381-7059

Provider Enumeration Date	:	04/09/2020
Last Update Date	:	04/09/2020

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