MEDICARE: ENHANCED COSMETIC AND IMPLANT DENTISTRY

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	1223D0001X	Public Health Dentistry

General Provider Information

NPI Number	:	1942929898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENHANCED COSMETIC AND IMPLANT DENTISTRY

Provider Business Mailing Address
First Line	:	2840 E FLAMINGO RD STE G
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5202
Country	:	US
Telephone Number	:	702-224-2762
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 E WARM SPRINGS RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4283
Country	:	US
Telephone Number	:	725-765-9500
Fax Number	:	702-541-9849

Authorized Official
Title or Position	:	INSURANCE MANAGER
Name	:	JENNIFER GARDEL
Credential	:
Telephone Number	:	702-224-2762

Provider Enumeration Date	:	08/24/2022
Last Update Date	:	08/24/2022

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