Provider Demographics
NPI:1942929898
Name:ENHANCED COSMETIC AND IMPLANT DENTISTRY
Entity Type:Organization
Organization Name:ENHANCED COSMETIC AND IMPLANT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-224-2762
Mailing Address - Street 1:2840 E FLAMINGO RD STE G
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5202
Mailing Address - Country:US
Mailing Address - Phone:702-224-2762
Mailing Address - Fax:
Practice Address - Street 1:340 E WARM SPRINGS RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-4283
Practice Address - Country:US
Practice Address - Phone:725-765-9500
Practice Address - Fax:702-541-9849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty