Provider Demographics
NPI:1912607433
Name:MODERN DENTAL SPECIALIST, LLC
Entity Type:Organization
Organization Name:MODERN DENTAL SPECIALIST, LLC
Other - Org Name:MODERN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HUMAN RESOURSE
Authorized Official - Prefix:
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVCIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-623-3200
Mailing Address - Street 1:4618 MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2956
Mailing Address - Country:US
Mailing Address - Phone:702-623-3200
Mailing Address - Fax:
Practice Address - Street 1:4618 MEADOWS LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2956
Practice Address - Country:US
Practice Address - Phone:702-623-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty