MEDICARE: ONE DENTAL GROUP 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	:	1982373957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE DENTAL GROUP LLC

Provider Business Mailing Address
First Line	:	3041 HUSHED SONNET AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89044-0558
Country	:	US
Telephone Number	:	702-401-9955
Fax Number	:

Provider Business Practice Location Address
First Line	:	4250 S RAINBOW BLVD STE 1004
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3134
Country	:	US
Telephone Number	:	702-456-4600
Fax Number	:

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	IRENE HAN
Credential	:	DMD
Telephone Number	:	702-401-9955

Provider Enumeration Date	:	09/12/2021
Last Update Date	:	09/12/2021

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Directions to “ONE DENTAL GROUP LLC ” Practice Location

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