Provider Demographics
NPI:1417460411
Name:POUYA MOMTAZ DMD PLLC
Entity Type:Organization
Organization Name:POUYA MOMTAZ DMD PLLC
Other - Org Name:ALIGN ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:POUYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOMTAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:702-546-9936
Mailing Address - Street 1:445 W CRAIG RD STE 121
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-1232
Mailing Address - Country:US
Mailing Address - Phone:702-399-9118
Mailing Address - Fax:
Practice Address - Street 1:445 W CRAIG RD STE 121
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-1232
Practice Address - Country:US
Practice Address - Phone:702-399-9118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS3-3041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty