| Aqua Dental Group Llc | |
|
2500 Wigwam Pkwy Ste 110 Henderson NV 89074-7113 | |
| (702) 522-9192 | |
| Not Available |
| Full Name | Aqua Dental Group Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2500 Wigwam Pkwy Ste 110, Henderson, Nevada |
| Authorized Official Name and Position | Leila Khossoosi (MANAGER) |
| Authorized Official Contact | 7025229192 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Aqua Dental Group Llc 2285 E Flamingo Rd Ste 101 Las Vegas NV 89119-5114 Ph: (702) 522-9192 | Aqua Dental Group Llc 2500 Wigwam Pkwy Ste 110 Henderson NV 89074-7113 Ph: (702) 522-9192 |
| NPI Number | 1518523729 |
|---|---|
| Provider Enumeration Date | 05/13/2019 |
| Last Update Date | 05/13/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518523729 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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