Healthcare Provider Details

I. General information

NPI: 1033488051
Provider Name (Legal Business Name): ARTISTIC ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 BLUE DIAMOND RD #100
LAS VEGAS NV
89139-7661
US

IV. Provider business mailing address

8370 W CHEYENNE AVE #103
LAS VEGAS NV
89129-8404
US

V. Phone/Fax

Practice location:
  • Phone: 702-877-2200
  • Fax: 702-395-7496
Mailing address:
  • Phone: 702-877-2200
  • Fax: 702-395-7426

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: FARSHAD ZAGHI
Title or Position: OWNER
Credential:
Phone: 702-435-5015