Healthcare Provider Details

I. General information

NPI: 1679353049
Provider Name (Legal Business Name): PDCA SAHARA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8981 W SAHARA AVE STE 110
LAS VEGAS NV
89117-5894
US

IV. Provider business mailing address

3600 N BUFFALO DR STE 110
LAS VEGAS NV
89129-7462
US

V. Phone/Fax

Practice location:
  • Phone: 702-254-4220
  • Fax:
Mailing address:
  • Phone: 702-254-8858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CARLA LALANDE CORDOVA
Title or Position: MANAGING MEMBER
Credential: DMD MSD
Phone: 702-254-8858