Provider Demographics
NPI:1699556001
Name:MODERN DENTAL SPECIALIST, LLC
Entity type:Organization
Organization Name:MODERN DENTAL SPECIALIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR
Authorized Official - Prefix:
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVCIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-449-2643
Mailing Address - Street 1:4618 MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2956
Mailing Address - Country:US
Mailing Address - Phone:702-200-9000
Mailing Address - Fax:
Practice Address - Street 1:6965 S RAINBOW BLVD STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3280
Practice Address - Country:US
Practice Address - Phone:702-200-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty