# ANTHEM VILLAGE DENTAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043362981
- **Authorized official:** DR. ROBERT WILFORD NISSON DDS (OFFICER IN CORPORATION)
- **Authorized official phone:** (702) 454-7704

## Contact information

- **Practice address:** 2571 ANTHEM VILLAGE DR, SUITE \#5, HENDERSON, NV 89052-5508
- **Practice address phone:** (702) 454-7704
- **Practice address fax:** (702) 454-0200
- **Mailing address:** 2571 ANTHEM VILLAGE DR, SUITE \#5, HENDERSON, NV 89052-5508
- **Mailing address phone:** (702) 454-7704
- **Mailing address fax:** (702) 454-0200

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 132074 | NV | Yes |

## Other

- **Enumeration date:** 01/18/2007
- **Last updated:** 08/22/2020