MEDICARE: ABC DENTAL CARE PLLC

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	:	1679289201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABC DENTAL CARE PLLC

Provider Business Mailing Address
First Line	:	1235 PANINI DR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-3143
Country	:	US
Telephone Number	:	402-650-4126
Fax Number	:

Provider Business Practice Location Address
First Line	:	7219 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2870
Country	:	US
Telephone Number	:	402-650-4126
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OWNER
Name	:	DR. JOHN WALKER
Credential	:	DDS
Telephone Number	:	402-650-4126

Provider Enumeration Date	:	01/26/2023
Last Update Date	:	01/26/2023

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