Provider Demographics
NPI:1386762201
Name:MOHTASHAMI, SEAN S (DDS)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:S
Last Name:MOHTASHAMI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7510 W SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2742
Mailing Address - Country:US
Mailing Address - Phone:702-220-6666
Mailing Address - Fax:702-220-8050
Practice Address - Street 1:7510 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2742
Practice Address - Country:US
Practice Address - Phone:702-220-6666
Practice Address - Fax:702-220-8050
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3059122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty