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General NPI Number Information
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NPI Number | 1477183101
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Entity Type | Organization
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Legal Business Name | AMERITINA DENTAL EASTERN LLC
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Dates
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Enumeration Date | 01/22/2020
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Last Update Date | 01/22/2020
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Provider Practice Location Address
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Address Line | 581 N EASTERN AVE
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City | LAS VEGAS
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State | NV
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Zip | 89101-3422
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Country | US
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Telephone | 702-444-7810
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Fax | 702-445-6299
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Provider Business Mailing Address
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Address Line | 2810 BELLINI DR
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City | HENDERSON
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State | NV
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Zip | 89052-3118
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Country | US
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Telephone | 646-592-5597
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Fax | 702-722-2277
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Authorized Official
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Title or Position | CEO
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Name | ARASH BAKHAJ
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Credential | DDS
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Telephone | 646-592-5597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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