MEDICARE: SMOKE RANCH DENTAL GUBLER, DDS LTD

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	122300000X	Dentist	3331	NV

General Provider Information

NPI Number	:	1568472686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMOKE RANCH DENTAL GUBLER, DDS LTD

Provider Business Mailing Address
First Line	:	6669 SMOKE RANCH RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-8419
Country	:	US
Telephone Number	:	702-869-8031
Fax Number	:	702-658-4327

Provider Business Practice Location Address
First Line	:	6669 SMOKE RANCH RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-8419
Country	:	US
Telephone Number	:	702-869-8031
Fax Number	:	702-656-7557

Authorized Official
Title or Position	:	VP, OPERATIONS
Name	:	DAVID WOLINSKY
Credential	:
Telephone Number	:	702-322-2200

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/16/2013

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