Provider Demographics
NPI:1720177512
Name:ABSOLUTE DENTAL-SPARKS
Entity Type:Organization
Organization Name:ABSOLUTE DENTAL-SPARKS
Other - Org Name:
Other - Org Type:
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:DDS
Authorized Official - Phone:775-331-8400
Mailing Address - Street 1:1301 N MCCARRAN BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-3877
Mailing Address - Country:US
Mailing Address - Phone:775-331-8400
Mailing Address - Fax:775-359-9336
Practice Address - Street 1:1301 N MCCARRAN BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-3877
Practice Address - Country:US
Practice Address - Phone:775-331-8400
Practice Address - Fax:775-359-9336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV45091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty