Provider Demographics
NPI:1922569607
Name:4G DENTAL PARTNERS
Entity type:Organization
Organization Name:4G DENTAL PARTNERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WYATT
Authorized Official - Middle Name:STOTT
Authorized Official - Last Name:DANNELS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-456-0005
Mailing Address - Street 1:4750 W SAHARA AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-3559
Mailing Address - Country:US
Mailing Address - Phone:702-381-7059
Mailing Address - Fax:702-979-5864
Practice Address - Street 1:4235 E CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-2380
Practice Address - Country:US
Practice Address - Phone:702-456-0005
Practice Address - Fax:702-920-8892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental