Provider Demographics
NPI:1578885521
Name:P3 DENTAL - WELEBIR PC
Entity Type:Organization
Organization Name:P3 DENTAL - WELEBIR PC
Other - Org Name:MADDISON AVENUE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:BEATRIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-578-6591
Mailing Address - Street 1:P3 DENTAL - WELEBIR PC
Mailing Address - Street 2:1131 S. CASINO BLVD
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104
Mailing Address - Country:US
Mailing Address - Phone:702-648-2094
Mailing Address - Fax:702-648-0875
Practice Address - Street 1:4358 WEST CHEYENNE AVENUE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032
Practice Address - Country:US
Practice Address - Phone:702-735-9500
Practice Address - Fax:702-586-1592
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:P3 DENTAL - WELEBIR PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-18
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty