Provider Demographics
NPI:1083233001
Name:FLAMINGO DENTAL PARTNERS LLC
Entity Type:Organization
Organization Name:FLAMINGO DENTAL PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WYATT
Authorized Official - Middle Name:S
Authorized Official - Last Name:DANNELS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-381-7059
Mailing Address - Street 1:6680 W FLAMINGO RD STE A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-2189
Mailing Address - Country:US
Mailing Address - Phone:702-389-4039
Mailing Address - Fax:702-389-1887
Practice Address - Street 1:6680 W FLAMINGO RD STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2189
Practice Address - Country:US
Practice Address - Phone:702-389-4039
Practice Address - Fax:702-389-1887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty