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General NPI Number Information
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NPI Number | 1972045300
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Entity Type | Organization
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Legal Business Name | AMERTINA DENTAL GROUP AND ORTHODONTICS
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 4492 S PECOS RD
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City | LAS VEGAS
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State | NV
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Zip | 89121-5030
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Country | US
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Telephone | 702-602-2300
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Fax | 702-899-0499
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Provider Business Mailing Address
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Address Line | 4492 S PECOS RD
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City | LAS VEGAS
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State | NV
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Zip | 89121-5030
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Country | US
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Telephone | 702-602-2300
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Fax | 702-899-0499
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Authorized Official
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Title or Position | OWNER
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Name | ARASH BAKHAJ
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Credential | DDS
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Telephone | 702-602-2300
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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 | S3-275
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | S3-275
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | S3-275
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | S3-275
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License Number State | NV
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