Provider Demographics
NPI:1124162383
Name:CARAHALIS, JOHN T X
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:CARAHALIS
Suffix:X
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 E LAKE MEAD BLVD
Mailing Address - Street 2:#6
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-6512
Mailing Address - Country:US
Mailing Address - Phone:702-649-7708
Mailing Address - Fax:702-649-8074
Practice Address - Street 1:2700 E LAKE MEAD BLVD
Practice Address - Street 2:#6
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6512
Practice Address - Country:US
Practice Address - Phone:702-649-7708
Practice Address - Fax:702-649-8074
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV35171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice