Provider Demographics
NPI:1740520188
Name:HASHTROUDI, SAMAN NICHOLAS (DMD)
Entity type:Individual
Prefix:DR
First Name:SAMAN
Middle Name:NICHOLAS
Last Name:HASHTROUDI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 TECHNOLOGY PARK STE 101
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-7122
Mailing Address - Country:US
Mailing Address - Phone:702-254-7507
Mailing Address - Fax:702-254-5523
Practice Address - Street 1:320 N NELLIS BLVD STE 4
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5390
Practice Address - Country:US
Practice Address - Phone:702-453-7200
Practice Address - Fax:702-437-4022
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV63681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice