Healthcare Provider Details

I. General information

NPI: 1609131572
Provider Name (Legal Business Name): FAMILY CARE ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 07/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 S EASTERN AVE
LAS VEGAS NV
89119-5101
US

IV. Provider business mailing address

4045 S EASTERN AVE
LAS VEGAS NV
89119-5101
US

V. Phone/Fax

Practice location:
  • Phone: 702-892-9878
  • Fax:
Mailing address:
  • Phone: 702-892-9878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-215
License Number StateNV

VIII. Authorized Official

Name: SABA ASRAR
Title or Position: OWNER
Credential:
Phone: 702-575-7871