MEDICARE: ABSOLUTE DENTAL ALIANTE, 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	1223G0001X	General Practice Dentistry	4566	NV

General Provider Information

NPI Number	:	1851488431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABSOLUTE DENTAL ALIANTE, INC.

Provider Business Mailing Address
First Line	:	3040 W ANN RD
Second Line	:	SUITE 101
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-7265
Country	:	US
Telephone Number	:	702-839-2244
Fax Number	:	702-839-1415

Provider Business Practice Location Address
First Line	:	3040 W ANN RD
Second Line	:	SUITE 101
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-7265
Country	:	US
Telephone Number	:	702-839-2244
Fax Number	:	702-839-1415

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LEONID BANCHIK
Credential	:	D.M.D
Telephone Number	:	702-839-2244

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	08/22/2020

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