Provider Demographics
NPI:1972045300
Name:AMERTINA DENTAL GROUP AND ORTHODONTICS
Entity Type:Organization
Organization Name:AMERTINA DENTAL GROUP AND ORTHODONTICS
Other - Org Name:NEVADA DENTISTRY & BRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARASH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKHAJ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-602-2300
Mailing Address - Street 1:4492 S PECOS RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5030
Mailing Address - Country:US
Mailing Address - Phone:702-602-2300
Mailing Address - Fax:702-899-0499
Practice Address - Street 1:4492 S PECOS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5030
Practice Address - Country:US
Practice Address - Phone:702-602-2300
Practice Address - Fax:702-899-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS3-2751223G0001X, 1223P0221X, 1223S0112X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty