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NPI Code Detail

MEDICARE: TELADENTIST PC INC

MEDICARE: TELADENTIST PC INC
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/Center5053NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689101750
Entity Type Code : Organization
Provider Name (Legal Business Name) : TELADENTIST PC INC
Provider Business Mailing Address
First Line : 9030 W SAHARA AVE # 699
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-5744
Country : US
Telephone Number : 888-588-3394
Fax Number :
Provider Business Practice Location Address
First Line : 6127 S RAINBOW BLVD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118
Country : US
Telephone Number : 888-588-3394
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. VILAS SASTRY
Credential : DMD
Telephone Number : 888-588-3394
Provider Enumeration Date : 05/19/2017
Last Update Date : 12/28/2023

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Directions to “TELADENTIST PC INC ” Practice Location

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