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NPI Code Detail

MEDICARE: TENDER DENTAL BONANZA, LLC

MEDICARE: TENDER 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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1679227839
Entity Type Code : Organization
Provider Name (Legal Business Name) : TENDER DENTAL BONANZA, LLC
Provider Business Mailing Address
First Line : 5001 E BONANZA RD STE 160
Second Line :
City : LAS VEGAS
State : NV
Zip : 89110-3560
Country : US
Telephone Number : 702-307-2273
Fax Number :
Provider Business Practice Location Address
First Line : 5001 E BONANZA RD STE 160
Second Line :
City : LAS VEGAS
State : NV
Zip : 89110-3560
Country : US
Telephone Number : 702-307-2273
Fax Number :
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : DR. MICHAEL LAWRENCE SHERMAN
Credential :
Telephone Number : 631-806-1275
Provider Enumeration Date : 02/07/2022
Last Update Date : 02/07/2022

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Directions to “TENDER DENTAL BONANZA, LLC ” Practice Location

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