4g Dental Partners
Clinic/Center, Dental in Las Vegas, NV. Organization (NPI-2).
NPI number1922569607
StatusActive
Last updated in NPPESJun 11, 2019
Details
- NPI
- 1922569607
- Entity type
- Organization (NPI-2)
- Legal business name
- 4g Dental Partners
- Organization subpart
- No
- Enumeration date
- Mar 26, 2019
- Last updated
- Jun 11, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Other names
- Boca Dental & Braces (Doing Business As)
Practice location
4235 E Charleston BlvdLas Vegas, NV 89104-2380
Phone 702-456-0005 · Fax 702-920-8892
Mailing address
4750 W Sahara Ave Ste 12Las Vegas, NV 89102-3559
Phone 702-381-7059 · Fax 702-979-5864
Authorized official
Wyatt Stott Dannels
Owner
7024560005
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