Organization
BOCA DENTAL PREMIER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY WILCOX (DIRECTOR OF BILLING)
(702) 703-1590
Entity
Organization
Contact information
Practice address
2018 LAKE TAHOE BLVD, SOUTH LAKE TAHOE, CA 96150-6402
(702) 703-1590
Mailing address
8989 W FLAMINGO RD, LAS VEGAS, NV 89147-0431
(702) 703-1590
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
08/11/2025
Last updated
09/05/2025
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