MEDICARE: HARMON AND OTTESON DENTAL BONANZA 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	:	1508551706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARMON AND OTTESON DENTAL BONANZA LLC

Provider Business Mailing Address
First Line	:	2337 E BONANZA RD STE 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-3418
Country	:	US
Telephone Number	:	702-307-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	2337 E BONANZA RD STE 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-3418
Country	:	US
Telephone Number	:	702-307-2273
Fax Number	:

Authorized Official
Title or Position	:	OPERATIONS PARTNER
Name	:	KENDRA M EBERT
Credential	:
Telephone Number	:	765-669-1254

Provider Enumeration Date	:	04/05/2023
Last Update Date	:	04/05/2023

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Directions to “HARMON AND OTTESON DENTAL BONANZA LLC ” Practice Location

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