Provider Demographics
NPI:1356077440
Name:POUYA MOMTAZ DMD PLLC
Entity Type:Organization
Organization Name:POUYA MOMTAZ DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:POUYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOMTAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSC
Authorized Official - Phone:702-546-9936
Mailing Address - Street 1:7445 S DURANGO DR STE 103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3611
Mailing Address - Country:US
Mailing Address - Phone:702-546-9936
Mailing Address - Fax:
Practice Address - Street 1:7445 S DURANGO DR STE 103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-3611
Practice Address - Country:US
Practice Address - Phone:702-546-9936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty