Provider Demographics
NPI:1962223784
Name:MW DENTAL PROF. LLC
Entity type:Organization
Organization Name:MW DENTAL PROF. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:WENDELBOE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-860-5829
Mailing Address - Street 1:6825 ANTLER CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-9602
Mailing Address - Country:US
Mailing Address - Phone:702-860-5829
Mailing Address - Fax:702-636-1688
Practice Address - Street 1:10010 W CHEYENNE AVE STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7714
Practice Address - Country:US
Practice Address - Phone:702-227-4392
Practice Address - Fax:702-636-1688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental