MEDICARE: ARTISTIC ORTHODONTICS- MEADOWS

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	S3-200	NV

General Provider Information

NPI Number	:	1588960439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARTISTIC ORTHODONTICS- MEADOWS

Provider Business Mailing Address
First Line	:	8370 W CHEYENNE AVE STE 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-2174
Country	:	US
Telephone Number	:	702-877-2200
Fax Number	:	702-395-7246

Provider Business Practice Location Address
First Line	:	4300 MEADOWS LN
Second Line	:	1350
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-3004
Country	:	US
Telephone Number	:	702-472-7320
Fax Number	:	702-258-1069

Authorized Official
Title or Position	:	OWNER
Name	:	FARSHAD ZAGHI
Credential	:
Telephone Number	:	702-435-5015

Provider Enumeration Date	:	02/09/2011
Last Update Date	:	02/09/2011

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