MEDICARE: SHARIFIAN CHARLESTON DENTAL GROUP, PC, A NEVADA PROFESSIONAL CORP

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1255427142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHARIFIAN CHARLESTON DENTAL GROUP, PC, A NEVADA PROFESSIONAL CORP

Provider Business Mailing Address
First Line	:	2860 MICHELLE
Second Line	:	2ND FLOOR
City	:	IRVINE
State	:	CA
Zip	:	92606-1009
Country	:	US
Telephone Number	:	714-508-3600
Fax Number	:	714-368-2092

Provider Business Practice Location Address
First Line	:	2001 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2228
Country	:	US
Telephone Number	:	702-366-1407
Fax Number	:	702-853-0533

Authorized Official
Title or Position	:	OWNER DDS
Name	:	DR. ALEX R SHARIFIAN
Credential	:	DDS
Telephone Number	:	702-650-3232

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	06/03/2009

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