# MODERN DENTAL SPECIALIST, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MODERN DENTAL SPECIALISTS, LLC
- **Other names:** Modern Dental Specialists
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1669207957
- **Legal business name:** MODERN DENTAL SPECIALISTS, LLC
- **Authorized official:** BENNY KOHANTEB DDS (DENTIST)
- **Authorized official phone:** (818) 631-3368

## Contact information

- **Practice address:** 4416 E BONANZA RD UNIT 120, LAS VEGAS, NV 89110-6349
- **Practice address phone:** (702) 200-9000
- **Mailing address:** 4618 MEADOWS LN, LAS VEGAS, NV 89107-2956
- **Mailing address phone:** (702) 200-9000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |
| 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