MEDICARE: P3 DENTAL - WELEBIR PC

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	:	1407325129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P3 DENTAL - WELEBIR PC

Provider Business Mailing Address
First Line	:	4358 W CHEYENNE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-2484
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4358 W CHEYENNE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-2484
Country	:	US
Telephone Number	:	702-735-9500
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, CREDENTIALING
Name	:	NICOLE KUEHN
Credential	:
Telephone Number	:	214-701-6694

Provider Enumeration Date	:	11/26/2018
Last Update Date	:	03/10/2026

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