Healthcare Provider Details

I. General information

NPI: 1366823973
Provider Name (Legal Business Name): DR ANNA SHAGHARYAN, DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 S RAMPART BLVD #240
LAS VEGAS NV
89145-4882
US

IV. Provider business mailing address

851 S RAMPART BLVD #240
LAS VEGAS NV
89145-4882
US

V. Phone/Fax

Practice location:
  • Phone: 702-933-1300
  • Fax: 702-932-1300
Mailing address:
  • Phone: 702-933-1300
  • Fax: 702-932-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number6646
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number6646
License Number StateNV

VIII. Authorized Official

Name: DR. ANNA SHAGHARYAN
Title or Position: DENTIST
Credential: DMD
Phone: 702-858-6815