Provider Demographics
NPI:1063929172
Name:SHIVA KESHMIRI DDS A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SHIVA KESHMIRI DDS A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIVA
Authorized Official - Middle Name:
Authorized Official - Last Name:KESHMIRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-257-9090
Mailing Address - Street 1:4121 W. SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102
Mailing Address - Country:US
Mailing Address - Phone:702-257-9090
Mailing Address - Fax:702-873-7263
Practice Address - Street 1:6600 W. CHARLESTON BLVD
Practice Address - Street 2:#103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146
Practice Address - Country:US
Practice Address - Phone:702-433-6825
Practice Address - Fax:702-821-1499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV45141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty