MEDICARE: FAMILY CARE ORTHODONTICS, INC.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	S3-156C	NV

General Provider Information

NPI Number	:	1164609988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY CARE ORTHODONTICS, INC.

Provider Business Mailing Address
First Line	:	8409 W LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7638
Country	:	US
Telephone Number	:	702-254-6700
Fax Number	:

Provider Business Practice Location Address
First Line	:	8409 W LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7638
Country	:	US
Telephone Number	:	702-254-6700
Fax Number	:

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. SABA ASRAR
Credential	:	DDS
Telephone Number	:	702-575-7871

Provider Enumeration Date	:	01/23/2008
Last Update Date	:	01/23/2008

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