Healthcare Provider Details

I. General information

NPI: 1164609988
Provider Name (Legal Business Name): FAMILY CARE ORTHODONTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8409 W LAKE MEAD BLVD
LAS VEGAS NV
89128-7638
US

IV. Provider business mailing address

8409 W LAKE MEAD BLVD
LAS VEGAS NV
89128-7638
US

V. Phone/Fax

Practice location:
  • Phone: 702-254-6700
  • Fax:
Mailing address:
  • Phone: 702-254-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-156C
License Number StateNV

VIII. Authorized Official

Name: DR. SABA ASRAR
Title or Position: ORTHODONTIST
Credential: DDS
Phone: 702-575-7871