MEDICARE: ARTISTIC ORTHODONTICS, 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
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1720244817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARTISTIC ORTHODONTICS, INC.

Provider Business Mailing Address
First Line	:	3040 W ANN RD
Second Line	:	#101
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-7265
Country	:	US
Telephone Number	:	702-839-2244
Fax Number	:	702-839-1415

Provider Business Practice Location Address
First Line	:	3040 W ANN RD
Second Line	:	#101
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-7265
Country	:	US
Telephone Number	:	702-839-2244
Fax Number	:	702-839-1415

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

Provider Enumeration Date	:	07/29/2008
Last Update Date	:	07/29/2008

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