Healthcare Provider Details

I. General information

NPI: 1356925796
Provider Name (Legal Business Name): SAM FARANESH DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2843 SAINT ROSE PKWY STE 100
HENDERSON NV
89052-4814
US

IV. Provider business mailing address

8184 TONE ST
LAS VEGAS NV
89123-0215
US

V. Phone/Fax

Practice location:
  • Phone: 702-492-1955
  • Fax: 702-492-7663
Mailing address:
  • Phone: 702-812-1316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SAMER FARANESH
Title or Position: PRESIDENT
Credential: DMD
Phone: 702-812-1316