# ALTA ORAL SURGERY, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821323205
- **Authorized official:** BENNY KOHANTEB (OWNER)
- **Authorized official phone:** (702) 435-5015

## Contact information

- **Practice address:** 526 S TONOPAH DR, \#200, LAS VEGAS, NV 89106-4043
- **Practice address phone:** (702) 435-5015
- **Practice address fax:** (702) 366-1483
- **Mailing address:** 526 S TONOPAH DR, \#200, LAS VEGAS, NV 89106-4043
- **Mailing address phone:** (702) 435-5015
- **Mailing address fax:** (702) 366-1483

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 4509 | NV | Yes |

## Other

- **Enumeration date:** 10/02/2009
- **Last updated:** 10/02/2009