Provider Demographics
NPI:1710258116
Name:WARM SPRINGS DENTAL OFFICE INC
Entity Type:Organization
Organization Name:WARM SPRINGS DENTAL OFFICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:YABUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-690-4487
Mailing Address - Street 1:770 E. WARM SPRINGS RD.
Mailing Address - Street 2:STE# 220
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-4347
Mailing Address - Country:US
Mailing Address - Phone:702-690-4487
Mailing Address - Fax:702-690-4486
Practice Address - Street 1:770 E WARM SPRINGS RD STE 220
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-4347
Practice Address - Country:US
Practice Address - Phone:702-690-4487
Practice Address - Fax:702-690-4486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDENTALOtherDENTAL