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General NPI Number Information
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NPI Number | 1538495148
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Entity Type | Organization
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Legal Business Name | NEVADA DENTAL SPECIALISTS, LLC
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Dates
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Enumeration Date | 11/02/2009
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Last Update Date | 11/02/2009
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Provider Practice Location Address
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Address Line | 971 TOPSY LN #333
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City | CARSON CITY
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State | NV
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Zip | 89705-8421
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Country | US
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Telephone | 775-884-4888
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Fax | 775-267-4288
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Provider Business Mailing Address
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Address Line | 526 S TONOPAH DR #200
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City | LAS VEGAS
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State | NV
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Zip | 89106-4043
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Country | US
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Telephone | 702-435-5015
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Fax | 702-366-1483
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Authorized Official
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Title or Position | OWNER
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Name | BENNY KOHANTEB
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Credential |
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Telephone | 702-435-5016
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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 | 4509
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License Number State | NV
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