MEDICARE: DR. EDILBERTO DE ANDRADE DDS

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	1223P0300X	Periodontics	S4-24	NV

General Provider Information

NPI Number	:	1114036969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDILBERTO DE ANDRADE DDS

Provider Business Mailing Address
First Line	:	2610 W HORIZON RIDGE PKWY
Second Line	:	SUITE 202
City	:	HENDERSON
State	:	NV
Zip	:	89052-2869
Country	:	US
Telephone Number	:	702-270-4600
Fax Number	:	702-270-7773

Provider Business Practice Location Address
First Line	:	2610 W HORIZON RIDGE PKWY
Second Line	:	SUITE 202
City	:	HENDERSON
State	:	NV
Zip	:	89052-2869
Country	:	US
Telephone Number	:	702-270-4600
Fax Number	:	702-270-7773

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	08/23/2017

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