MEDICARE: NEVADA DENTAL PROFESSIONAL, QUIRT, GATES, 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	:	1518679026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA DENTAL PROFESSIONAL, QUIRT, GATES, PC

Provider Business Mailing Address
First Line	:	6540 N LOSEE RD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1001
Country	:	US
Telephone Number	:	702-505-4772
Fax Number	:	702-505-4778

Provider Business Practice Location Address
First Line	:	6540 N LOSEE RD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1001
Country	:	US
Telephone Number	:	702-505-4772
Fax Number	:	702-505-4778

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	BELINDA HUERTA
Credential	:
Telephone Number	:	217-540-2100

Provider Enumeration Date	:	12/15/2022
Last Update Date	:	12/15/2022

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