Alta Oral Surgery, LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

4509 Issued in NV

Legal business name

ALTA ORAL SURGERY, LLC

Practice address

526 S Tonopah Dr
#200
Las Vegas, NV 89106-4043

Phone

(702) 435-5015

Fax

(702) 366-1483

NPI assigned

Oct 2, 2009

Last updated

Oct 2, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Benny Kohanteb

Title

Owner

Phone

(702) 435-5015

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1254441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254441600000",
    "number": "1821323205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "526 S TONOPAH DR",
            "address_2": "#200",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064043",
            "telephone_number": "702-435-5015",
            "fax_number": "702-366-1483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 S TONOPAH DR",
            "address_2": "#200",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064043",
            "telephone_number": "702-435-5015",
            "fax_number": "702-366-1483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTA ORAL SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-02",
        "last_updated": "2009-10-02",
        "status": "A",
        "authorized_official_last_name": "KOHANTEB",
        "authorized_official_first_name": "BENNY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-435-5015"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NV",
            "license": "4509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alta Care Home, Inc
• Alta Care Homehealth, Inc,
• Alta Care Hospice and Palliative Care Inc.
• Alta Medgen NV LLC
• Alta Medical Clinic Inc of Nevada
• Alta Wellness Center LLC
• Alta-Rose Surgery Center LLC
• Joelita Altabet
• Angelina Marie Altaf
• Jose Elias Altamirano Zeledon, MD

• Oral and Maxillofacial Surgery (Dentist) in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Oral and Maxillofacial Surgery (Dentist) in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.