Healthcare Provider Details

I. General information

NPI: 1053696443
Provider Name (Legal Business Name): ARTISTIC ORTHODONTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10660 SOUTHERN HIGHLANDS PKWY #100
LAS VEGAS NV
89141-4114
US

IV. Provider business mailing address

8370 W CHEYENNE AVE STE 103
LAS VEGAS NV
89129-2174
US

V. Phone/Fax

Practice location:
  • Phone: 702-877-2200
  • Fax: 702-395-7426
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 NumberS3-200
License Number StateNV

VIII. Authorized Official

Name: FARSHAD ZAGHI
Title or Position: OWNER
Credential:
Phone: 702-877-2200