MEDICARE: GHERIANI DENTAL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1073293973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GHERIANI DENTAL PLLC

Provider Business Mailing Address
First Line	:	5475 S FORT APACHE RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-6410
Country	:	US
Telephone Number	:	646-258-8282
Fax Number	:

Provider Business Practice Location Address
First Line	:	5475 S FORT APACHE RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-6410
Country	:	US
Telephone Number	:	702-702-1609
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. YASSER GHERIANI
Credential	:	DMD
Telephone Number	:	443-538-5871

Provider Enumeration Date	:	07/24/2023
Last Update Date	:	08/07/2023

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