# ABRAZA DENTAL GROUP LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1073963757
- **Authorized official:** WYATT STOTT DANNELS DDS (DDS)
- **Authorized official phone:** (702) 456-0005

## Contact information

- **Practice address:** 5642 S EASTERN AVE, SUITE B, LAS VEGAS, NV 89119-2375
- **Practice address phone:** (702) 456-0005
- **Mailing address:** 5642 S EASTERN AVE, SUITE B, LAS VEGAS, NV 89119-2375
- **Mailing address phone:** (702) 456-0005

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 6743 | NV | Yes |

## Other

- **Enumeration date:** 06/14/2016
- **Last updated:** 06/15/2016