Provider Demographics
NPI:1487362257
Name:LAS VEGAS DENTAL CENTER PLLC
Entity type:Organization
Organization Name:LAS VEGAS DENTAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:RAPHAEL
Authorized Official - Last Name:ABRAHAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-713-3036
Mailing Address - Street 1:5077 TRANQUIL STREAM CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1607
Mailing Address - Country:US
Mailing Address - Phone:860-713-3036
Mailing Address - Fax:
Practice Address - Street 1:5230 BOULDER HWY STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-6079
Practice Address - Country:US
Practice Address - Phone:702-851-6724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental