MEDICARE: MW DENTAL PROF. 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1962223784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MW DENTAL PROF. LLC

Provider Business Mailing Address
First Line	:	6825 ANTLER CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-9602
Country	:	US
Telephone Number	:	702-860-5829
Fax Number	:	702-636-1688

Provider Business Practice Location Address
First Line	:	10010 W CHEYENNE AVE STE 140
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7714
Country	:	US
Telephone Number	:	702-227-4392
Fax Number	:	702-636-1688

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	MICHAEL RAY WENDELBOE
Credential	:	DMD
Telephone Number	:	702-860-5829

Provider Enumeration Date	:	10/23/2024
Last Update Date	:	10/23/2024

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