Provider Demographics
NPI:1598181554
Name:SAHARA DENTAL SUMMERLIN
Entity Type:Organization
Organization Name:SAHARA DENTAL SUMMERLIN
Other - Org Name:SAHARA DENTAL PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SHIVA
Authorized Official - Middle Name:
Authorized Official - Last Name:KESHMIRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-257-9090
Mailing Address - Street 1:9690 W TROPICANA AVE
Mailing Address - Street 2:STE #110B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147
Mailing Address - Country:US
Mailing Address - Phone:702-433-8400
Mailing Address - Fax:702-434-8401
Practice Address - Street 1:9690 W TROPICANA AVE
Practice Address - Street 2:STE #110B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147
Practice Address - Country:US
Practice Address - Phone:702-433-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAHARA DENTAL PROFESSIONALS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV45141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty