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General NPI Number Information
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NPI Number | 1811084312
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Entity Type | Organization
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Legal Business Name | ABSOLUTE DENTAL-BONANZA INC.
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 556 N EASTERN AVE SUITE 1
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City | LAS VEGAS
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State | NV
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Zip | 89101-3477
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Country | US
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Telephone | 702-365-6800
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Fax | 702-366-9894
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Provider Business Mailing Address
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Address Line | 556 N EASTERN AVE SUITE 1
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City | LAS VEGAS
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State | NV
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Zip | 89101-3477
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Country | US
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Telephone | 702-365-6800
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Fax | 702-366-9894
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Authorized Official
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Title or Position | D.D.S.
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Name | DR. BENNY KOHANTEB
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Credential |
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Telephone | 702-365-6800
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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 | 4509
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License Number State | NV
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