Individual
DR. WAYNE ICHIKAWA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
1001 SHADOW LN # MS 7413, LAS VEGAS, NV 89106-4124
(702) 774-2457
(702) 774-2610
Mailing address
1001 SHADOW LN # MS 7413, LAS VEGAS, NV 89106-4124
(702) 774-2457
(702) 774-2610
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
29954
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
S2-147C
NV
Other
Enumeration date
01/15/2007
Last updated
03/08/2019
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