Provider Demographics
NPI:1811084312
Name:ABSOLUTE DENTAL-BONANZA INC.
Entity type:Organization
Organization Name:ABSOLUTE DENTAL-BONANZA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S.
Authorized Official - Prefix:DR
Authorized Official - First Name:BENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHANTEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-365-6800
Mailing Address - Street 1:556 N EASTERN AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-3477
Mailing Address - Country:US
Mailing Address - Phone:702-365-6800
Mailing Address - Fax:702-366-9894
Practice Address - Street 1:556 N EASTERN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-3477
Practice Address - Country:US
Practice Address - Phone:702-365-6800
Practice Address - Fax:702-366-9894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
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