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General NPI Number Information
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NPI Number | 1104912831
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Entity Type | Organization
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Legal Business Name | ABSOLUTE DENTAL LAKE MEAD, LLP
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2301 E LAKE MEAD BLVD
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City | N LAS VEGAS
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State | NV
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Zip | 89030-7137
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Country | US
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Telephone | 702-649-9333
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Fax | 702-639-0579
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Provider Business Mailing Address
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Address Line | 2301 E LAKE MEAD BLVD
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City | N LAS VEGAS
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State | NV
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Zip | 89030-7137
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Country | US
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Telephone | 702-649-9333
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Fax | 702-639-0579
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Authorized Official
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Title or Position | OWNER
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Name | DR. BENNY KOHANTEB
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Credential |
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Telephone | 702-218-2713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4509T
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License Number State | NV
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