MEDICARE: ANAHITA KHORAMSHAHI DMD

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	1223G0001X	General Practice Dentistry	7099	NV
2	122300000X	Dentist	7099	NV

General Provider Information

NPI Number	:	1275028342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANAHITA KHORAMSHAHI DMD

Provider Business Mailing Address
First Line	:	10548 MEADOW MIST AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-2029
Country	:	US
Telephone Number	:	818-404-0660
Fax Number	:

Provider Business Practice Location Address
First Line	:	6040 S RAINBOW BLVD STE B2
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2542
Country	:	US
Telephone Number	:	702-748-8508
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2018
Last Update Date	:	03/05/2024

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