MEDICARE: NEVADA ENDODONTICS LLC

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	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1225229016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA ENDODONTICS LLC

Provider Business Mailing Address
First Line	:	6950 SMOKE RANCH RD
Second Line	:	#125
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1300
Country	:	US
Telephone Number	:	702-243-8102
Fax Number	:	702-256-2047

Provider Business Practice Location Address
First Line	:	6950 SMOKE RANCH RD
Second Line	:	125
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1300
Country	:	US
Telephone Number	:	702-243-8102
Fax Number	:	702-256-2047

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL A. ALTERMAN
Credential	:
Telephone Number	:	702-243-8102

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	08/06/2007

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