MEDICARE: SHIVA KESHMIRI DDS (PC)

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	4514	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396913760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIVA KESHMIRI DDS (PC)

Provider Business Mailing Address
First Line	:	4121 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3704
Country	:	US
Telephone Number	:	702-257-9090
Fax Number	:	702-873-7263

Provider Business Practice Location Address
First Line	:	4121 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3704
Country	:	US
Telephone Number	:	702-257-9090
Fax Number	:	702-873-7263

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHIVA KESHMIRI
Credential	:	DDS
Telephone Number	:	702-257-9090

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	02/19/2008

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