MEDICARE: DR. MICHAEL JOSEPH WILLS DMD

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	6329	NV

General Provider Information

NPI Number	:	1932457702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOSEPH WILLS DMD

Provider Business Mailing Address
First Line	:	5670 W FLAMINGO RD
Second Line	:	SUITE B
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-0170
Country	:	US
Telephone Number	:	702-364-2373
Fax Number	:	702-364-8134

Provider Business Practice Location Address
First Line	:	5670 W FLAMINGO RD
Second Line	:	SUITE B
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-0170
Country	:	US
Telephone Number	:	702-364-2373
Fax Number	:	702-364-8134

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	08/27/2012

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