1538495148 NPI number — NEVADA DENTAL SPECIALISTS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538495148 NPI number — NEVADA DENTAL SPECIALISTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEVADA DENTAL SPECIALISTS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538495148
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
526 S TONOPAH DR
Provider Second Line Business Mailing Address:
#200
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89106-4043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-435-5015
Provider Business Mailing Address Fax Number:
702-366-1483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
971 TOPSY LN
Provider Second Line Business Practice Location Address:
#333
Provider Business Practice Location Address City Name:
CARSON CITY
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89705-8421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-884-4888
Provider Business Practice Location Address Fax Number:
775-267-4288
Provider Enumeration Date:
11/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KOHANTEB
Authorized Official First Name:
BENNY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
702-435-5016

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  4509 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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