Provider Demographics
NPI:1760912745
Name:TENDER DENTAL MEAD, LLC
Entity Type:Organization
Organization Name:TENDER DENTAL MEAD, LLC
Other - Org Name:LAS VEGAS ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-806-1275
Mailing Address - Street 1:7670 W LAKE MEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-6649
Mailing Address - Country:US
Mailing Address - Phone:702-312-2273
Mailing Address - Fax:
Practice Address - Street 1:7670 W LAKE MEAD BLVD STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-6651
Practice Address - Country:US
Practice Address - Phone:702-312-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TENDER DENTAL MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-13
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty