Provider Demographics
NPI:1174315121
Name:AMT DENTAL HOLDINGS LLC
Entity type:Organization
Organization Name:AMT DENTAL HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:THACKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-408-7224
Mailing Address - Street 1:11978 MONTAGUE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-6383
Mailing Address - Country:US
Mailing Address - Phone:702-408-7224
Mailing Address - Fax:
Practice Address - Street 1:1140 N TOWN CENTER DR STE 170
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0601
Practice Address - Country:US
Practice Address - Phone:702-463-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-17
Last Update Date:2025-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental