Provider Demographics
NPI:1861720864
Name:DESERT DENTAL ASSOCIATES IV, LLC
Entity type:Organization
Organization Name:DESERT DENTAL ASSOCIATES IV, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER- DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WELEBIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-953-2239
Mailing Address - Street 1:4358 W. CHYENNE AVE.
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032
Mailing Address - Country:US
Mailing Address - Phone:702-953-2239
Mailing Address - Fax:702-990-0304
Practice Address - Street 1:4358 W. CHYENNE AVE.
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032
Practice Address - Country:US
Practice Address - Phone:702-953-2239
Practice Address - Fax:702-990-0304
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESERT DENTAL ASSOCIATES, IV, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty