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General NPI Number Information
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NPI Number | 1780219287
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Entity Type | Organization
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Legal Business Name | CARLA CORDOVA DMD MSD LLC
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Dates
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Enumeration Date | 03/05/2020
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Last Update Date | 03/05/2020
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Provider Practice Location Address
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Address Line | 3603 LAS VEGAS BLVD N STE 120
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City | LAS VEGAS
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State | NV
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Zip | 89115-0588
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Country | US
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Telephone | 702-545-0055
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Fax | 702-254-9462
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Provider Business Mailing Address
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Address Line | 3600 N BUFFALO DR STE 110
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City | LAS VEGAS
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State | NV
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Zip | 89129-7462
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Country | US
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Telephone | 702-254-8858
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Fax | 702-254-9462
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Authorized Official
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Title or Position | MEMBER
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Name | CARLA LALANDE
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Credential | DMD
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Telephone | 702-254-8858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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