Healthcare Provider Details

I. General information

NPI: 1811242464
Provider Name (Legal Business Name): FAMILY CARE ORTHODONTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6116 W FLAMINGO RD
LAS VEGAS NV
89103-2280
US

IV. Provider business mailing address

6116 W FLAMINGO RD
LAS VEGAS NV
89103-2280
US

V. Phone/Fax

Practice location:
  • Phone: 702-369-5551
  • Fax:
Mailing address:
  • Phone: 702-369-5551
  • 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: DDS
Phone: 702-575-7871