MEDICARE: SHAHRESTANI LAS VEGAS MODERN DENTISTRY, PC

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

General Provider Information

NPI Number	:	1588943948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAHRESTANI LAS VEGAS MODERN DENTISTRY, PC

Provider Business Mailing Address
First Line	:	17000 RED HILL AVE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92614-5626
Country	:	US
Telephone Number	:	714-845-8890
Fax Number	:	949-474-1495

Provider Business Practice Location Address
First Line	:	7171 W CRAIG RD STE 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6018
Country	:	US
Telephone Number	:	702-655-0331
Fax Number	:	702-655-0377

Authorized Official
Title or Position	:	OWNER DOCTOR
Name	:	DR. ALI SHAHRESTANI
Credential	:	DMD
Telephone Number	:	702-655-0331

Provider Enumeration Date	:	08/16/2011
Last Update Date	:	01/03/2014

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