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General NPI Number Information
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NPI Number | 1689462798
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Entity Type | Individual
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Provider Name | DR. ANDY ALEXANDER LANDAVERDE
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Gender | Male
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 1825 S NELLIS BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89104-6215
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Country | US
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Telephone | 702-452-3552
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Fax |
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Provider Business Mailing Address
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Address Line | 115 COVENTRY CIR
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City | HENDERSON
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State | NV
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Zip | 89074-2725
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Country | US
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Telephone | 702-541-2496
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8215
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License Number State | NV
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