MEDICARE: BABAK ERSHAGHI DDS

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	3351	NV

General Provider Information

NPI Number	:	1427066778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BABAK ERSHAGHI DDS

Provider Business Mailing Address
First Line	:	3250 N TENAYA WAY
Second Line	:	STE 108
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7406
Country	:	US
Telephone Number	:	702-656-3910
Fax Number	:	702-656-9120

Provider Business Practice Location Address
First Line	:	3250 N TENAYA WAY
Second Line	:	STE 108
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7406
Country	:	US
Telephone Number	:	702-656-3910
Fax Number	:	702-656-9120

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/08/2007

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