MEDICARE: DESERT DENTAL

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	5852	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487884268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT DENTAL

Provider Business Mailing Address
First Line	:	55 S. VALLE VERDE DR.
Second Line	:	SUITE #250
City	:	HENDERSON
State	:	NV
Zip	:	89012
Country	:	US
Telephone Number	:	702-260-1890
Fax Number	:	702-260-7936

Provider Business Practice Location Address
First Line	:	55 S VALLE VERDE DR
Second Line	:	SUITE #250
City	:	HENDERSON
State	:	NV
Zip	:	89012-3433
Country	:	US
Telephone Number	:	702-260-1890
Fax Number	:	702-260-7936

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. ILYA BENJAMIN
Credential	:	DMD
Telephone Number	:	702-260-1890

Provider Enumeration Date	:	07/15/2009
Last Update Date	:	07/10/2013

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Directions to “DESERT DENTAL ” Practice Location

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