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General NPI Number Information
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NPI Number | 1295145852
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Entity Type | Organization
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Legal Business Name | SHIRAZ DENTAL, LLC
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Dates
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Enumeration Date | 05/05/2014
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Last Update Date | 05/05/2014
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Provider Practice Location Address
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Address Line | 4510 S EASTERN AVE STE 2
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City | LAS VEGAS
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State | NV
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Zip | 89119-6118
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Country | US
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Telephone | 702-368-0911
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Fax | 702-734-6884
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Provider Business Mailing Address
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Address Line | 4510 S EASTERN AVE STE 2
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City | LAS VEGAS
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State | NV
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Zip | 89119-6118
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Country | US
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Telephone | 702-368-0911
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Fax | 702-734-6884
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | MS. SALMEH JAFARIFAR
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Credential | DDS
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Telephone | 702-236-5010
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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 | 4565
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License Number State | NV
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