Provider Demographics
NPI:1679049217
Name:ONE & ONLY DENTISTRY LLC
Entity Type:Organization
Organization Name:ONE & ONLY DENTISTRY LLC
Other - Org Name:DREAM DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-260-1890
Mailing Address - Street 1:2747 PARADISE RD UNIT 1002
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-9057
Mailing Address - Country:US
Mailing Address - Phone:702-326-5448
Mailing Address - Fax:
Practice Address - Street 1:8685 W SAHARA AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5880
Practice Address - Country:US
Practice Address - Phone:702-260-1890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty