1740520188 NPI number — DR. SAMAN NICHOLAS HASHTROUDI DMD

Table of content: DR. SAMAN NICHOLAS HASHTROUDI DMD (NPI 1740520188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740520188 NPI number — DR. SAMAN NICHOLAS HASHTROUDI DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASHTROUDI
Provider First Name:
SAMAN
Provider Middle Name:
NICHOLAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1740520188
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 TECHNOLOGY PARK STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE MARY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32746-7122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-254-7507
Provider Business Mailing Address Fax Number:
702-254-5523

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 N NELLIS BLVD STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89110-5390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-453-7200
Provider Business Practice Location Address Fax Number:
702-437-4022
Provider Enumeration Date:
02/21/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  6368 , 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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