Provider Demographics
NPI:1649358300
Name:TWESME, ALBERT THEODORE (DDS)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:THEODORE
Last Name:TWESME
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:A.
Other - Middle Name:TED
Other - Last Name:TWESME
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4544 S PECOS RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5923
Mailing Address - Country:US
Mailing Address - Phone:702-436-0900
Mailing Address - Fax:702-436-0636
Practice Address - Street 1:4544 S PECOS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5923
Practice Address - Country:US
Practice Address - Phone:702-436-0900
Practice Address - Fax:702-436-0636
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS2-481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2202018Medicaid
NVT75462Medicare UPIN