Provider Demographics
NPI:1790940005
Name:LMJ DENTAL, LLC
Entity Type:Organization
Organization Name:LMJ DENTAL, LLC
Other - Org Name:ABSOLUTE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
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 1:6110 W LAKE MEAD BLVD
Mailing Address - Street 2:STE. 150
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-2659
Mailing Address - Country:US
Mailing Address - Phone:702-435-5015
Mailing Address - Fax:702-366-1483
Practice Address - Street 1:6110 W LAKE MEAD BLVD
Practice Address - Street 2:STE. 150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-2659
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:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty