Provider Demographics
NPI:1780334755
Name:MAHON WINEMAN COMMUNITY DENTAL SERVICES PC
Entity type:Organization
Organization Name:MAHON WINEMAN COMMUNITY DENTAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECERTARY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ARMSTRONG
Authorized Official - Last Name:WINEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-270-4800
Mailing Address - Street 1:2193 HORSE PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5834
Mailing Address - Country:US
Mailing Address - Phone:702-242-1644
Mailing Address - Fax:
Practice Address - Street 1:825 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:TONOPAH
Practice Address - State:NV
Practice Address - Zip Code:89049
Practice Address - Country:US
Practice Address - Phone:702-326-9461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental