Provider Demographics
NPI:1134391683
Name:ABSOLUTE DENTAL FARM ROAD LLC
Entity type:Organization
Organization Name:ABSOLUTE DENTAL FARM ROAD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENNY
Authorized Official - Middle Name:K
Authorized Official - Last Name:KOHANTEB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-435-5015
Mailing Address - Street 1:501 S RANCHO DR
Mailing Address - Street 2:B-11
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4828
Mailing Address - Country:US
Mailing Address - Phone:702-435-5015
Mailing Address - Fax:702-366-1483
Practice Address - Street 1:8430 FARM RD
Practice Address - Street 2:120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-8166
Practice Address - Country:US
Practice Address - Phone:702-435-5015
Practice Address - Fax:702-366-1483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty