Provider Demographics
NPI:1356925796
Name:SAM FARANESH DMD, PC
Entity type:Organization
Organization Name:SAM FARANESH DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:FARANESH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-812-1316
Mailing Address - Street 1:8184 TONE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-0215
Mailing Address - Country:US
Mailing Address - Phone:702-812-1316
Mailing Address - Fax:
Practice Address - Street 1:2843 SAINT ROSE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4814
Practice Address - Country:US
Practice Address - Phone:702-492-1955
Practice Address - Fax:702-492-7663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty