Provider Demographics
NPI:1275028342
Name:KHORAMSHAHI, ANAHITA (DMD)
Entity Type:Individual
Prefix:
First Name:ANAHITA
Middle Name:
Last Name:KHORAMSHAHI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10548 MEADOW MIST AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2029
Mailing Address - Country:US
Mailing Address - Phone:818-404-0660
Mailing Address - Fax:
Practice Address - Street 1:6040 S RAINBOW BLVD STE B2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2542
Practice Address - Country:US
Practice Address - Phone:702-748-8508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV70991223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice