Organization
MODERN DENTAL SPECIALIST, LLC
Active
Other names
Modern Dental Specialists
Organization subpart
No
Provider details
NPI number
Authorized official
BENNY KOHANTEB DDS (DENTIST)
(818) 631-3368
Entity
Organization
Contact information
Practice address
4610 E SUNSET RD, HENDERSON, NV 89014-2202
(702) 200-9000
Mailing address
4618 MEADOWS LN, LAS VEGAS, NV 89107-2956
(702) 623-3200
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
1223P0300X
Periodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
04/06/2023
Last updated
04/06/2023
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