Provider Demographics
NPI:1366823973
Name:DR ANNA SHAGHARYAN, DMD, PC
Entity Type:Organization
Organization Name:DR ANNA SHAGHARYAN, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAGHARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-858-6815
Mailing Address - Street 1:851 S RAMPART BLVD
Mailing Address - Street 2:#240
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-4882
Mailing Address - Country:US
Mailing Address - Phone:702-933-1300
Mailing Address - Fax:702-932-1300
Practice Address - Street 1:851 S RAMPART BLVD
Practice Address - Street 2:#240
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-4882
Practice Address - Country:US
Practice Address - Phone:702-933-1300
Practice Address - Fax:702-932-1300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6646302R00000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization