MEDICARE: ONE & ONLY DENTISTRY 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

General Provider Information

NPI Number	:	1679049217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE & ONLY DENTISTRY LLC

Provider Business Mailing Address
First Line	:	2747 PARADISE RD UNIT 1002
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-9057
Country	:	US
Telephone Number	:	702-326-5448
Fax Number	:

Provider Business Practice Location Address
First Line	:	8685 W SAHARA AVE STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5880
Country	:	US
Telephone Number	:	702-260-1890
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ILYA BENJAMIN
Credential	:	DMD
Telephone Number	:	702-260-1890

Provider Enumeration Date	:	10/22/2018
Last Update Date	:	10/22/2018

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Directions to “ONE & ONLY DENTISTRY LLC ” Practice Location

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