Healthcare Provider Details

I. General information

NPI: 1740538214
Provider Name (Legal Business Name): BNT ORTHODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 S DECATUR BLVD
LAS VEGAS NV
89102-8510
US

IV. Provider business mailing address

1350 S DECATUR BLVD
LAS VEGAS NV
89102-8510
US

V. Phone/Fax

Practice location:
  • Phone: 702-870-1350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-119
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-193C
License Number StateNV

VIII. Authorized Official

Name: DR. LEONARDO CARLOS BORDADOR
Title or Position: OWNER
Credential: DMD, MS
Phone: 702-870-1350