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NPI Code Detail

MEDICARE: RAINCHARLIE DENTAL, LLC

MEDICARE: RAINCHARLIE DENTAL, 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
1261QD0000XDental Clinic/CenterNV20111452524NV

General Provider Information

NPI Number : 1679841258
Entity Type Code : Organization
Provider Name (Legal Business Name) : RAINCHARLIE DENTAL, LLC
Provider Business Mailing Address
First Line : 526 S TONOPAH DR
Second Line : #200
City : LAS VEGAS
State : NV
Zip : 89106-4043
Country : US
Telephone Number : 402-435-5015
Fax Number : 702-366-1483
Provider Business Practice Location Address
First Line : 945 S RAINBOW BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89145-6230
Country : US
Telephone Number : 702-331-8585
Fax Number : 702-382-4469
Authorized Official
Title or Position : OWNER
Name : BENNY KOHANTEB
Credential :
Telephone Number : 702-435-5015
Provider Enumeration Date : 12/09/2011
Last Update Date : 12/09/2011

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Directions to “RAINCHARLIE DENTAL, LLC ” Practice Location

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