Provider Demographics
NPI:1063980142
Name:P3 DENTAL - WELEBIR PC
Entity type:Organization
Organization Name:P3 DENTAL - WELEBIR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:BEATRIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-578-6591
Mailing Address - Street 1:1131 S CASINO CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4955 S DURANGO DR STE 201
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-0156
Practice Address - Country:US
Practice Address - Phone:702-933-7275
Practice Address - Fax:702-933-0596
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:P3 DENTAL - WELEBIR PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty