Healthcare Provider Details

I. General information

NPI: 1821196940
Provider Name (Legal Business Name): CAREY BRUCE NOORDA D.D.S., M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N GREEN VALLEY PKWY STE 1
HENDERSON NV
89074-5886
US

IV. Provider business mailing address

1701 N GREEN VALLEY PKWY STE 1
HENDERSON NV
89074-5886
US

V. Phone/Fax

Practice location:
  • Phone: 702-737-5500
  • Fax: 702-737-5565
Mailing address:
  • Phone: 702-737-5500
  • Fax: 702-737-5565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2223 S3-37
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: