Provider Demographics
NPI:1932313053
Name:WILLIAM E, URSICK, GEMINI DENTAL
Entity Type:Organization
Organization Name:WILLIAM E, URSICK, GEMINI DENTAL
Other - Org Name:OASIS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GROUP MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAMALA
Authorized Official - Middle Name:MCCOOK
Authorized Official - Last Name:CASSANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-369-0021
Mailing Address - Street 1:2110 E FLAMINGO RD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5190
Mailing Address - Country:US
Mailing Address - Phone:702-369-0021
Mailing Address - Fax:702-369-9644
Practice Address - Street 1:2110 E FLAMINGO RD
Practice Address - Street 2:SUITE 315
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5190
Practice Address - Country:US
Practice Address - Phone:702-369-0021
Practice Address - Fax:702-369-9644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV09871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty