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General NPI Number Information
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NPI Number | 1245005081
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Entity Type | Organization
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Legal Business Name | GENTLE DENTISTRY OF LAS VEGAS LLC
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Dates
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Enumeration Date | 11/21/2023
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 501 S RANCHO DR STE G48
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City | LAS VEGAS
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State | NV
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Zip | 89106-4835
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Country | US
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Telephone | 702-474-2454
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 35835
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City | LAS VEGAS
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State | NV
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Zip | 89133-5835
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | FARAH DIVANBEIGI
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Credential | DDS
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Telephone | 702-524-2675
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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 |
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License Number State |
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