Healthcare Provider Details

I. General information

NPI: 1538496120
Provider Name (Legal Business Name): NEVADA DENTAL SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6490 S MCCARRAN BLVD #17
RENO NV
89509-6165
US

IV. Provider business mailing address

526 S TONOPAH DR STE 200
LAS VEGAS NV
89106-4013
US

V. Phone/Fax

Practice location:
  • Phone: 775-787-8900
  • Fax: 775-829-8901
Mailing address:
  • Phone: 702-435-5015
  • Fax: 702-366-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: BENNY KOHANTEB
Title or Position: OWNER
Credential:
Phone: 702-435-5015