MEDICARE: ARTISTIC ORTHODONTICS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1447406103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARTISTIC ORTHODONTICS

Provider Business Mailing Address
First Line	:	8370 W CHEYENNE AVE
Second Line	:	STE. 103
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8404
Country	:	US
Telephone Number	:	702-877-2200
Fax Number	:	702-645-6869

Provider Business Practice Location Address
First Line	:	2301 E LAKE MEAD BLVD
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89030-7137
Country	:	US
Telephone Number	:	702-641-5888
Fax Number	:	702-639-0579

Authorized Official
Title or Position	:	OWNER
Name	:	FARSHAD A ZAGHI
Credential	:	DMD
Telephone Number	:	702-877-2200

Provider Enumeration Date	:	08/13/2008
Last Update Date	:	08/13/2008

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Directions to “ARTISTIC ORTHODONTICS ” Practice Location

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