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Organization
MODERN DENTAL SPECIALIST, LLC
Active
Organization
MODERN DENTAL SPECIALIST, LLC
Active
Other names
Modern Dental Specialists
Organization subpart
No
Provider details
NPI number
Authorized official
BENNY KOHANTEB DDS (DENTIST)
(818) 631-3368
Entity
Organization
Contact information
Practice address
4610 E SUNSET RD, HENDERSON, NV 89014-2202
(702) 200-9000
Mailing address
4618 MEADOWS LN, LAS VEGAS, NV 89107-2956
(702) 623-3200
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
NULL
1223E0200X
Endodontics
Primary
—
—
1223P0300X
Periodontics
—
NULL
1223P0300X
Periodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
04/06/2023
Last updated
04/06/2023
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