Healthcare Provider Details

I. General information

NPI: 1174487110
Provider Name (Legal Business Name): LDL DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7435 S EASTERN AVE STE 104
LAS VEGAS NV
89123-1508
US

IV. Provider business mailing address

7435 S EASTERN AVE STE 104
LAS VEGAS NV
89123-1508
US

V. Phone/Fax

Practice location:
  • Phone: 702-272-3790
  • Fax:
Mailing address:
  • Phone: 702-272-3790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LILIAN DIAZ LAGO
Title or Position: OWNER
Credential: DMD
Phone: 702-272-3790