Provider Demographics
NPI:1609095561
Name:ENDALKACHEW MERSHA D.M.D,A PROFESSIONAL CORPATION
Entity Type:Organization
Organization Name:ENDALKACHEW MERSHA D.M.D,A PROFESSIONAL CORPATION
Other - Org Name:DISCOVERY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ORELLANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-889-5000
Mailing Address - Street 1:2350 S JONES BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-3124
Mailing Address - Country:US
Mailing Address - Phone:702-889-2624
Mailing Address - Fax:702-889-6131
Practice Address - Street 1:2350 S JONES BLVD STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3124
Practice Address - Country:US
Practice Address - Phone:702-889-2624
Practice Address - Fax:702-889-6131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV33621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty