Provider Demographics
NPI:1033488051
Name:ARTISTIC ORTHODONTICS
Entity Type:Organization
Organization Name:ARTISTIC ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARSHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAGHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-435-5015
Mailing Address - Street 1:8370 W CHEYENNE AVE
Mailing Address - Street 2:#103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-8404
Mailing Address - Country:US
Mailing Address - Phone:702-877-2200
Mailing Address - Fax:702-395-7426
Practice Address - Street 1:4720 BLUE DIAMOND RD
Practice Address - Street 2:#100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-7661
Practice Address - Country:US
Practice Address - Phone:702-877-2200
Practice Address - Fax:702-395-7496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty