MEDICARE: SEAN S MOHTASHAMI DDS

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	122300000X	Dentist	3059	NV

General Provider Information

NPI Number	:	1386762201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN S MOHTASHAMI DDS

Provider Business Mailing Address
First Line	:	7510 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2742
Country	:	US
Telephone Number	:	702-220-6666
Fax Number	:	702-220-8050

Provider Business Practice Location Address
First Line	:	7510 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2742
Country	:	US
Telephone Number	:	702-220-6666
Fax Number	:	702-220-8050

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	11/25/2024

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