| NPI | 1235588237 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM FRANKLIN WAGGONER Owner 702-339-6729 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: NV S6-17) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2016-06-09 |