Healthcare Provider Details

I. General information

NPI: 1407187792
Provider Name (Legal Business Name): JAHNAVI RAO ,DDS,MS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2010
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6127 S RAINBOW BLVD STE 100
LAS VEGAS NV
89118-3256
US

IV. Provider business mailing address

6127 S RAINBOW BLVD STE 100
LAS VEGAS NV
89118-3256
US

V. Phone/Fax

Practice location:
  • Phone: 702-998-2237
  • Fax: 702-243-2893
Mailing address:
  • Phone: 702-998-2237
  • Fax: 702-243-2893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5476
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-186
License Number StateNV

VIII. Authorized Official

Name: DR. JAHNAVI RAO
Title or Position: OWNER
Credential: DDS,MS
Phone: 702-998-2237