MEDICARE: ARTISTIC ORTHODONTICS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	S3-200	NV

General Provider Information

NPI Number	:	1053696443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARTISTIC ORTHODONTICS, INC

Provider Business Mailing Address
First Line	:	8370 W CHEYENNE AVE STE 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-2174
Country	:	US
Telephone Number	:	702-877-2200
Fax Number	:	702-395-7426

Provider Business Practice Location Address
First Line	:	10660 SOUTHERN HIGHLANDS PKWY
Second Line	:	#100
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-4114
Country	:	US
Telephone Number	:	702-877-2200
Fax Number	:	702-395-7426

Authorized Official
Title or Position	:	OWNER
Name	:	FARSHAD ZAGHI
Credential	:
Telephone Number	:	702-877-2200

Provider Enumeration Date	:	10/17/2011
Last Update Date	:	10/17/2011

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