Healthcare Provider Details

I. General information

NPI: 1730291873
Provider Name (Legal Business Name): SCOTT E LEAVER DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 MEADOWS LN
LAS VEGAS NV
89107-2965
US

IV. Provider business mailing address

4610 MEADOWS LN
LAS VEGAS NV
89107-2965
US

V. Phone/Fax

Practice location:
  • Phone: 702-878-0764
  • Fax:
Mailing address:
  • Phone: 702-878-0764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-58
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: