Provider Demographics
NPI:1871222620
Name:GREEN VALLEY DENTAL PARTNERS
Entity Type:Organization
Organization Name:GREEN VALLEY DENTAL PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-371-0221
Mailing Address - Street 1:10420 S DECATUR BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-8718
Mailing Address - Country:US
Mailing Address - Phone:702-371-0221
Mailing Address - Fax:
Practice Address - Street 1:223 N PECOS RD STE 130
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7362
Practice Address - Country:US
Practice Address - Phone:702-371-0221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental