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General NPI Number Information
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NPI Number | 1689101750
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Entity Type | Organization
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Legal Business Name | TELADENTIST PC INC
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Dates
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Enumeration Date | 05/19/2017
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 6127 S RAINBOW BLVD STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89118
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Country | US
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Telephone | 888-588-3394
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Fax |
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Provider Business Mailing Address
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Address Line | 9030 W SAHARA AVE # 699
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City | LAS VEGAS
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State | NV
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Zip | 89117-5744
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Country | US
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Telephone | 888-588-3394
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. VILAS SASTRY
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Credential | DMD
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Telephone | 888-588-3394
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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 | 5053
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License Number State | NV
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