Provider Demographics
NPI:1154084309
Name:ADA NEVADA DENTAL LLC
Entity Type:Organization
Organization Name:ADA NEVADA DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:GREENWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,PHARMD,MACSD
Authorized Official - Phone:504-952-0344
Mailing Address - Street 1:5230 BOULDER HWY STE 130
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-6079
Mailing Address - Country:US
Mailing Address - Phone:702-851-6724
Mailing Address - Fax:
Practice Address - Street 1:5230 BOULDER HWY STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-6079
Practice Address - Country:US
Practice Address - Phone:702-851-6724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty