Provider Demographics
NPI:1538496120
Name:NEVADA DENTAL SPECIALISTS, LLC
Entity Type:Organization
Organization Name:NEVADA DENTAL SPECIALISTS, LLC
Other - Org Name:NEVADA DENTAL SPECIALISTS- O.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHANTEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-435-5015
Mailing Address - Street 1:526 S TONOPAH DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4013
Mailing Address - Country:US
Mailing Address - Phone:702-435-5015
Mailing Address - Fax:702-366-1483
Practice Address - Street 1:6490 S MCCARRAN BLVD
Practice Address - Street 2:#17
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6165
Practice Address - Country:US
Practice Address - Phone:775-787-8900
Practice Address - Fax:775-829-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty