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NPI Code Detail

MEDICARE: ADAM BRENT KORNHABER

MEDICARE: ADAM BRENT KORNHABER
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
11223G0001XGeneral Practice DentistryLL-500-19NV

General Provider Information

NPI Number : 1902367659
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADAM BRENT KORNHABER
Provider Business Mailing Address
First Line : 1700 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2335
Country : US
Telephone Number : 702-774-5175
Fax Number : 702-774-2812
Provider Business Practice Location Address
First Line : 2656 N BUFFALO DR UNIT 1239
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-4812
Country : US
Telephone Number : 702-774-5175
Fax Number : 702-774-2812
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2019
Last Update Date : 07/10/2019

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Directions to “ ADAM BRENT KORNHABER ” Practice Location

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