MEDICARE: AMT DENTAL HOLDINGS 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1174315121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMT DENTAL HOLDINGS LLC

Provider Business Mailing Address
First Line	:	11978 MONTAGUE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6383
Country	:	US
Telephone Number	:	702-408-7224
Fax Number	:

Provider Business Practice Location Address
First Line	:	1140 N TOWN CENTER DR STE 170
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-0601
Country	:	US
Telephone Number	:	702-463-8600
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. MATTHEW THACKER
Credential	:	DMD
Telephone Number	:	702-408-7224

Provider Enumeration Date	:	05/17/2025
Last Update Date	:	05/17/2025

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Directions to “AMT DENTAL HOLDINGS LLC ” Practice Location

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