MEDICARE: NICHOLAS EDWARD LORDS D.D.S.

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	122300000X	Dentist	2642	NV

General Provider Information

NPI Number	:	1114147527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS EDWARD LORDS D.D.S.

Provider Business Mailing Address
First Line	:	2950 S RAINBOW BLVD
Second Line	:	SUITE 200
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6244
Country	:	US
Telephone Number	:	702-227-6510
Fax Number	:	702-227-0539

Provider Business Practice Location Address
First Line	:	2950 S RAINBOW BLVD
Second Line	:	SUITE 200
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6244
Country	:	US
Telephone Number	:	702-227-6510
Fax Number	:	702-227-0539

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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