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1811 S Rainbow Blvd Ste 202 Las Vegas NV 89146-0855 | |
| (702) 838-5400 | |
| (702) 838-5031 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1811 S Rainbow Blvd Ste 202, Las Vegas, Nevada |
| Authorized Official Name and Position | Gregg R Kolebuck (DENTIST / OWNER) |
| Authorized Official Contact | 7028385400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1811 S Rainbow Blvd Ste 202 Las Vegas NV 89146-0855 Ph: (702) 838-5400 | 1811 S Rainbow Blvd Ste 202 Las Vegas NV 89146-0855 Ph: (702) 838-5400 |
| NPI Number | 1164646295 |
|---|---|
| Provider Enumeration Date | 04/12/2007 |
| Last Update Date | 03/19/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164646295 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 3337 (Nevada) | Primary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Secondary |
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