Provider Demographics
NPI:1760645360
Name:EASTTROP DENTAL GROUP
Entity Type:Organization
Organization Name:EASTTROP DENTAL GROUP
Other - Org Name:ABSOLUTE DENTAL- TROPICANA
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:DDS
Authorized Official - Phone:702-435-5015
Mailing Address - Street 1:2425 E TROPICANA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5416
Mailing Address - Country:US
Mailing Address - Phone:702-435-5015
Mailing Address - Fax:702-366-1483
Practice Address - Street 1:2425 E TROPICANA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5416
Practice Address - Country:US
Practice Address - Phone:702-435-5015
Practice Address - Fax:702-366-1483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV45091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty