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NPI Code Detail

MEDICARE: ADA NEVADA DENTAL LLC

MEDICARE: ADA NEVADA DENTAL 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
1122300000XDentist

General Provider Information

NPI Number : 1760145916
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADA NEVADA DENTAL 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 : 702-307-2275
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 : 702-307-2275
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : DR. GREGORY WALTER GREENWOOD
Credential : DMD, PHARMD, MACSD
Telephone Number : 504-952-0344
Provider Enumeration Date : 10/14/2021
Last Update Date : 10/14/2021

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Directions to “ADA NEVADA DENTAL LLC ” Practice Location

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