MEDICARE: TENDER DENTAL MEAD, 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
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1760912745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENDER DENTAL MEAD, LLC

Provider Business Mailing Address
First Line	:	7670 W LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-6649
Country	:	US
Telephone Number	:	702-312-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	7670 W LAKE MEAD BLVD STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-6651
Country	:	US
Telephone Number	:	702-312-2273
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	DR. MICHAEL LAWRENCE SHERMAN
Credential	:
Telephone Number	:	631-806-1275

Provider Enumeration Date	:	06/13/2017
Last Update Date	:	02/04/2022

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