MEDICARE: TELADENTIST PC 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	261QD0000X	Dental Clinic/Center	5053	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	:	1689101750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TELADENTIST PC INC

Provider Business Mailing Address
First Line	:	9030 W SAHARA AVE # 699
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5744
Country	:	US
Telephone Number	:	888-588-3394
Fax Number	:

Provider Business Practice Location Address
First Line	:	6127 S RAINBOW BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118
Country	:	US
Telephone Number	:	888-588-3394
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VILAS SASTRY
Credential	:	DMD
Telephone Number	:	888-588-3394

Provider Enumeration Date	:	05/19/2017
Last Update Date	:	12/28/2023

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Directions to “TELADENTIST PC INC ” Practice Location

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