Healthcare Provider Details

I. General information

NPI: 1689614893
Provider Name (Legal Business Name): CARLOS H LETELIER MD.,DMD.,DDS.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10115 W TWAIN AVE STE 100
LAS VEGAS NV
89147
US

IV. Provider business mailing address

10115 W TWAIN AVE STE 100
LAS VEGAS NV
89147
US

V. Phone/Fax

Practice location:
  • Phone: 702-367-6666
  • Fax: 702-367-9555
Mailing address:
  • Phone: 702-367-6666
  • Fax: 702-367-9555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License NumberSPG139-AA
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberS2-40C
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberGA146
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number9658
License Number StateNV
# 5
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberS2-40C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: