Provider Demographics
NPI:1952192015
Name:DENTAL IMPLANT SPECIALISTS OF NEVADA - WILLARDSEN, PC
Entity type:Organization
Organization Name:DENTAL IMPLANT SPECIALISTS OF NEVADA - WILLARDSEN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLARDSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-481-0089
Mailing Address - Street 1:3500 MAPLE AVE STE 1150
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-3949
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9061 W POST RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2411
Practice Address - Country:US
Practice Address - Phone:702-434-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty