=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821231838
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARLA LALANDE DMD MSD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2009
-----------------------------------------------------
Last Update Date | 04/07/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3600 N BUFFALO DR #110
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89129-7463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-254-8858
-----------------------------------------------------
Fax | 702-254-9462
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3600 N BUFFALO DR #110
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89129-7463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-254-8858
-----------------------------------------------------
Fax | 702-254-9462
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PEDIATRIC DENTIST
-----------------------------------------------------
Name | DR. CARLA LALANDE
-----------------------------------------------------
Credential | DMD, MSD
-----------------------------------------------------
Telephone | 702-254-8858
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 5677
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------