Modern Dental Specialist, LLC

NPI #1669207957 in Las Vegas, Nevada

Provider Information

NPI Number: 1669207957
Entity Type: Organization
Organization Name: Modern Dental Specialist, LLC
Subpart: Yes (part of a larger organization)
Parent Organization: MODERN DENTAL SPECIALISTS, LLC
Primary Specialty: Dentist
Enumeration Date: Sep 5, 2024
Last Updated: Sep 5, 2024

Practice Location

Address: 4416 E BONANZA RD UNIT 120
City: Las Vegas
State: Nevada
ZIP Code: 89110-6349
Phone: (702) 200-9000

Authorized Official

Name: BENNY KOHANTEB, DDS
Title: DENTIST
Phone: (818) 631-3368

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Endodontics — Endodontics	1223E0200X
Dentist - Oral and Maxillofacial Pathology — Oral and Maxillofacial Pathology	1223P0106X
Dentist - Pediatric Dentistry — Pediatric Dentistry	1223P0221X
Dentist - Periodontics — Periodontics	1223P0300X
Dentist	122300000X	Primary

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