MEDICARE: DR. GHASSAN HANNA KHALAF D.D.S.

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	4289	NV

General Provider Information

NPI Number	:	1679678387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GHASSAN HANNA KHALAF D.D.S.

Provider Business Mailing Address
First Line	:	3774 E DESERT INN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3339
Country	:	US
Telephone Number	:	650-740-2200
Fax Number	:	314-248-2200

Provider Business Practice Location Address
First Line	:	3774 E DESERT INN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3339
Country	:	US
Telephone Number	:	702-257-2872
Fax Number	:	314-248-2200

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	09/08/2008

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