Provider Demographics
NPI:1396085320
Name:WILLIAM O. DAHLKE, JR., DMD,PLLC
Entity type:Organization
Organization Name:WILLIAM O. DAHLKE, JR., DMD,PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:OTTO
Authorized Official - Last Name:DAHLKE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-658-6700
Mailing Address - Street 1:6169 S RAINBOW BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-3231
Mailing Address - Country:US
Mailing Address - Phone:702-658-6700
Mailing Address - Fax:702-450-6711
Practice Address - Street 1:6169 S RAINBOW BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3231
Practice Address - Country:US
Practice Address - Phone:702-658-6700
Practice Address - Fax:702-450-6711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS6-1161223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty