Provider Demographics
NPI:1508039009
Name:ABSOLUTE DENTAL CARSON CITY, LLC
Entity Type:Organization
Organization Name:ABSOLUTE DENTAL CARSON CITY, LLC
Other - Org Name:ABSOLUTE DENTAL- CARSON CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENNY
Authorized Official - Middle Name:B
Authorized Official - Last Name:KOHANTEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-435-5015
Mailing Address - Street 1:971 TOPSY LN
Mailing Address - Street 2:#333
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89705-8421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:971 TOPSY LN
Practice Address - Street 2:#333
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89705-8421
Practice Address - Country:US
Practice Address - Phone:702-435-5015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty