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Organization
MODERN DENTAL SPECIALIST, LLC
Active
Organization
MODERN DENTAL SPECIALIST, LLC
Active
Parent organization
MODERN DENTAL SPECIALISTS, LLC
Other names
Modern Dental Specialists
Organization subpart
Yes
Provider details
NPI number
Legal business name
MODERN DENTAL SPECIALISTS, LLC
Authorized official
BENNY KOHANTEB DDS (DENTIST)
(818) 631-3368
Entity
Organization
Contact information
Practice address
4416 E BONANZA RD UNIT 120, LAS VEGAS, NV 89110-6349
(702) 200-9000
Mailing address
4618 MEADOWS LN, LAS VEGAS, NV 89107-2956
(702) 200-9000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
NULL
122300000X
Dentist
Primary
—
—
1223E0200X
Endodontics
—
NULL
1223E0200X
Endodontics
—
—
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
NULL
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
NULL
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
—
NULL
1223P0300X
Periodontics
—
—
Other
Enumeration date
09/05/2024
Last updated
09/05/2024
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