MEDICARE: SMILES TODAY DENTAL GROUP, 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	122300000X	Dentist	4647	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	:	1407146111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILES TODAY DENTAL GROUP, LLC

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	:	OWNER/DENTIST
Name	:	DR. AMMAR KERIO
Credential	:	DMD
Telephone Number	:	702-655-6777

Provider Enumeration Date	:	04/14/2011
Last Update Date	:	05/28/2014

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