Healthcare Provider Details

I. General information

NPI: 1912118878
Provider Name (Legal Business Name): HAROUT V GOSTANIAN DDS, MSD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 MALL RING CIR
HENDERSON NV
89014-6683
US

IV. Provider business mailing address

731 MALL RING CIR
HENDERSON NV
89014-6683
US

V. Phone/Fax

Practice location:
  • Phone: 702-734-5333
  • Fax: 702-990-0304
Mailing address:
  • Phone: 702-734-5333
  • Fax: 702-990-0304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberNV20071588351
License Number StateNV

VIII. Authorized Official

Name: DR. HAROUT V GOSTANIAN
Title or Position: OWNER
Credential: DDS, MSD
Phone: 702-734-5333