Healthcare Provider Details

I. General information

NPI: 1174613921
Provider Name (Legal Business Name): LEONARDO CARLOS FERRER BORDADOR DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 SUNRIDGE HEIGHTS PKWY STE 100
HENDERSON NV
89052-5055
US

IV. Provider business mailing address

2737 LAGUNA SECA AVE
HENDERSON NV
89052-4428
US

V. Phone/Fax

Practice location:
  • Phone: 702-878-2799
  • Fax: 702-436-2799
Mailing address:
  • Phone: 310-936-4382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number053200
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-193C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: