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Organization
MODERN DENTAL SPECIALIST, LLC
Active
Organization
MODERN DENTAL SPECIALIST, LLC
Active
Other names
Modern Dental
Organization subpart
No
Provider details
NPI number
Authorized official
BENNY KOHANTEB DDS (DENTIST)
(818) 631-3368
Entity
Organization
Contact information
Practice address
6388 W SAHARA AVE, LAS VEGAS, NV 89146-3050
(702) 288-7200
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
—
—
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
NULL
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
—
1223P0300X
Periodontics
—
NULL
1223P0300X
Periodontics
—
—
Other
Enumeration date
04/06/2023
Last updated
04/06/2023
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