Provider Demographics
NPI:1295465946
Name:JW DENTAL PLLC
Entity Type:Organization
Organization Name:JW DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JADEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:435-773-2752
Mailing Address - Street 1:11000 PINE KNOLLS CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-1652
Mailing Address - Country:US
Mailing Address - Phone:435-773-2752
Mailing Address - Fax:
Practice Address - Street 1:653 N TOWN CENTER DR
Practice Address - Street 2:SUITE 508
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144
Practice Address - Country:US
Practice Address - Phone:702-228-8777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental