MEDICARE: DR. AMMAR KERIO DMD

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	4647T	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4647T	OTHER	NV	DENTAL LINCENSE

General Provider Information

NPI Number	:	1275615882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMMAR KERIO DMD

Provider Business Mailing Address
First Line	:	1580 E DESERT INN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-2548
Country	:	US
Telephone Number	:	702-655-6777
Fax Number	:	702-547-3522

Provider Business Practice Location Address
First Line	:	1580 E DESERT INN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-2548
Country	:	US
Telephone Number	:	702-655-6777
Fax Number	:	702-547-3522

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	02/26/2013

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