MEDICARE: DENTAL ANESTHESIA SERVICES 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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1518249705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL ANESTHESIA SERVICES LLC

Provider Business Mailing Address
First Line	:	6885 ALIANTE PKWY
Second Line	:	SUITE 11
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-5811
Country	:	US
Telephone Number	:	702-515-1888
Fax Number	:

Provider Business Practice Location Address
First Line	:	6885 ALIANTE PKWY
Second Line	:	SUITE 11
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-5811
Country	:	US
Telephone Number	:	702-515-1888
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	STUART WEICHERS
Credential	:	MD
Telephone Number	:	702-515-1888

Provider Enumeration Date	:	09/13/2011
Last Update Date	:	09/13/2011

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