MEDICARE: BUFFALO215DENTAL 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
1	122300000X	Dentist

General Provider Information

NPI Number	:	1942184288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUFFALO215DENTAL LLC

Provider Business Mailing Address
First Line	:	6530 S BUFFALO DR STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2169
Country	:	US
Telephone Number	:	702-505-9199
Fax Number	:	702-505-4866

Provider Business Practice Location Address
First Line	:	6530 S BUFFALO DR STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2169
Country	:	US
Telephone Number	:	702-505-9199
Fax Number	:	702-505-4866

Authorized Official
Title or Position	:	DENTIST
Name	:	AMANPREET BATH
Credential	:	DDS
Telephone Number	:	510-209-1230

Provider Enumeration Date	:	07/31/2025
Last Update Date	:	07/31/2025

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