MEDICARE: ERNESTO BARBOSA DMD, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	8361	NV
2	122300000X	Dentist	6060	NV

General Provider Information

NPI Number	:	1043582810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERNESTO BARBOSA DMD, P.C.

Provider Business Mailing Address
First Line	:	1264 S NELLIS BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-5782
Country	:	US
Telephone Number	:	702-243-2489
Fax Number	:	702-438-4428

Provider Business Practice Location Address
First Line	:	1264 S NELLIS BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-5782
Country	:	US
Telephone Number	:	702-243-2489
Fax Number	:	702-438-4428

Authorized Official
Title or Position	:	OWNER
Name	:	ERNESTO BARBOSA
Credential	:
Telephone Number	:	702-278-0876

Provider Enumeration Date	:	02/08/2012
Last Update Date	:	02/08/2012

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