Provider Demographics
NPI:1376609305
Name:GEORGE A TANKSLEY JR DMD A PROFESSINAL CORPORATION
Entity Type:Organization
Organization Name:GEORGE A TANKSLEY JR DMD A PROFESSINAL CORPORATION
Other - Org Name:ALLIANCE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:TANKSLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-364-9700
Mailing Address - Street 1:4250 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 1004
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-3159
Mailing Address - Country:US
Mailing Address - Phone:702-364-9700
Mailing Address - Fax:702-364-9943
Practice Address - Street 1:4250 S RAINBOW BLVD
Practice Address - Street 2:SUITE 1004
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3159
Practice Address - Country:US
Practice Address - Phone:702-364-9700
Practice Address - Fax:702-364-9943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV46191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty