# MODERN DENTAL SPECIALIST, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Modern Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962197897
- **Authorized official:** BENNY KOHANTEB DDS (DENTIST)
- **Authorized official phone:** (818) 631-3368

## Contact information

- **Practice address:** 6388 W SAHARA AVE, LAS VEGAS, NV 89146-3050
- **Practice address phone:** (702) 288-7200
- **Mailing address:** 4618 MEADOWS LN, LAS VEGAS, NV 89107-2956
- **Mailing address phone:** (702) 623-3200

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | NULL | Yes |
| 1223E0200X | Endodontics | — | — | Yes |
| 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