Provider Demographics
NPI:1477183101
Name:AMERITINA DENTAL EASTERN LLC
Entity type:Organization
Organization Name:AMERITINA DENTAL EASTERN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARASH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKHAJ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-592-5597
Mailing Address - Street 1:2810 BELLINI DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3118
Mailing Address - Country:US
Mailing Address - Phone:646-592-5597
Mailing Address - Fax:702-722-2277
Practice Address - Street 1:581 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-3422
Practice Address - Country:US
Practice Address - Phone:702-444-7810
Practice Address - Fax:702-445-6299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental