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Organization
BLUE DENTAL, LLC
Active
Organization
BLUE DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENNY KOHANTEB DDS (OWNER)
(702) 435-5015
Entity
Organization
Contact information
Practice address
8380 W CHEYENNE AVE, 102, LAS VEGAS, NV 89129-8405
(702) 388-8989
(702) 396-0075
Mailing address
526 S TONOPAH DR, 200, LAS VEGAS, NV 89106-4043
(702) 435-5015
(702) 366-1483
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4509
NV
Other
Enumeration date
08/04/2015
Last updated
08/04/2015
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