Healthcare Provider Details

I. General information

NPI: 1699931790
Provider Name (Legal Business Name): ARTISTIC ORTHODONTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4035 S DURANGO DR #103
LAS VEGAS NV
89147-4161
US

IV. Provider business mailing address

4035 S DURANGO DR #103
LAS VEGAS NV
89147-4161
US

V. Phone/Fax

Practice location:
  • Phone: 702-804-8888
  • Fax: 702-804-0559
Mailing address:
  • Phone: 702-804-8888
  • Fax: 702-804-0559

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