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NPI Code Detail

MEDICARE: DENTAL IMPLANT SPECIALISTS OF NEVADA, GOLPA PC

MEDICARE: DENTAL IMPLANT SPECIALISTS OF NEVADA, GOLPA 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
11223G0001XGeneral Practice Dentistry
21223P0700XProsthodontics
3122300000XDentist

General Provider Information

NPI Number : 1720783277
Entity Type Code : Organization
Provider Name (Legal Business Name) : DENTAL IMPLANT SPECIALISTS OF NEVADA, GOLPA PC
Provider Business Mailing Address
First Line : 3500 MAPLE AVE STE 1600
Second Line :
City : DALLAS
State : TX
Zip : 75219-3936
Country : US
Telephone Number : 909-732-0191
Fax Number :
Provider Business Practice Location Address
First Line : 6420 MEDICAL CENTER ST STE 101
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-2402
Country : US
Telephone Number : 702-641-7111
Fax Number :
Authorized Official
Title or Position : OWNER DENTIST
Name : MIKE GOLPA
Credential :
Telephone Number : 702-768-7840
Provider Enumeration Date : 04/04/2023
Last Update Date : 04/06/2023

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Directions to “DENTAL IMPLANT SPECIALISTS OF NEVADA, GOLPA PC ” Practice Location

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