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General NPI Number Information
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NPI Number | 1356925796
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Entity Type | Organization
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Legal Business Name | SAM FARANESH DMD, PC
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Dates
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Enumeration Date | 05/11/2021
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Last Update Date | 05/11/2021
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Provider Practice Location Address
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Address Line | 2843 SAINT ROSE PKWY STE 100
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City | HENDERSON
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State | NV
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Zip | 89052-4814
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Country | US
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Telephone | 702-492-1955
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Fax | 702-492-7663
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Provider Business Mailing Address
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Address Line | 8184 TONE ST
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City | LAS VEGAS
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State | NV
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Zip | 89123-0215
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Country | US
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Telephone | 702-812-1316
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMER FARANESH
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Credential | DMD
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Telephone | 702-812-1316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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