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NPI Code Detail

MEDICARE: BONANZA DENTAL PARTNERS

MEDICARE: BONANZA DENTAL PARTNERS
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
1122300000XDentist

General Provider Information

NPI Number : 1114432531
Entity Type Code : Organization
Provider Name (Legal Business Name) : BONANZA DENTAL PARTNERS
Provider Business Mailing Address
First Line : 556 N EASTERN AVE STE I
Second Line :
City : LAS VEGAS
State : NV
Zip : 89101-3453
Country : US
Telephone Number : 702-960-4484
Fax Number : 702-987-3040
Provider Business Practice Location Address
First Line : 556 N EASTERN AVE STE I
Second Line :
City : LAS VEGAS
State : NV
Zip : 89101-3453
Country : US
Telephone Number : 702-960-4484
Fax Number : 702-987-3040
Authorized Official
Title or Position : OFFICE MANAGER
Name : DIANA J CAZZALY
Credential : DIANA CAZZALY
Telephone Number : 702-960-4484
Provider Enumeration Date : 12/07/2017
Last Update Date : 06/16/2018

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Directions to “BONANZA DENTAL PARTNERS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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