Provider Demographics
NPI:1043729171
Name:NADER AFSHARI DDS A DENTAL VENTURE INC
Entity type:Organization
Organization Name:NADER AFSHARI DDS A DENTAL VENTURE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NADER
Authorized Official - Middle Name:
Authorized Official - Last Name:AFSHARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-929-9284
Mailing Address - Street 1:4161 S EASTERN AVE STE E8
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5425
Mailing Address - Country:US
Mailing Address - Phone:702-233-1222
Mailing Address - Fax:702-233-1250
Practice Address - Street 1:4161 S EASTERN AVE STE E8
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5425
Practice Address - Country:US
Practice Address - Phone:818-274-2215
Practice Address - Fax:702-233-1250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV31791223G0001X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1043729171Medicaid
1063696110OtherMY INDIVIDUAL NPI NUMBER
1063696110OtherINDIVIDUAL NPI