Healthcare Provider Details

I. General information

NPI: 1679049217
Provider Name (Legal Business Name): ONE & ONLY DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8685 W SAHARA AVE STE 100
LAS VEGAS NV
89117-5880
US

IV. Provider business mailing address

2747 PARADISE RD UNIT 1002
LAS VEGAS NV
89109-9057
US

V. Phone/Fax

Practice location:
  • Phone: 702-260-1890
  • Fax:
Mailing address:
  • Phone: 702-326-5448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: ILYA BENJAMIN
Title or Position: PRESIDENT
Credential: DMD
Phone: 702-260-1890