Provider Demographics
NPI:1851582654
Name:ABSOLUTE DENTAL PAHRUMP LLC
Entity Type:Organization
Organization Name:ABSOLUTE DENTAL PAHRUMP LLC
Other - Org Name:ABSOLUTE DENTAL PAHRUMP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHANTEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-727-8818
Mailing Address - Street 1:150 S HIGHWAY 160
Mailing Address - Street 2:C-11
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-2176
Mailing Address - Country:US
Mailing Address - Phone:775-727-8818
Mailing Address - Fax:775-727-8870
Practice Address - Street 1:150 S HIGHWAY 160
Practice Address - Street 2:C-11
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-2176
Practice Address - Country:US
Practice Address - Phone:775-727-8818
Practice Address - Fax:775-727-8870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty