MEDICARE: LDL DENTAL PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1174487110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LDL DENTAL PLLC

Provider Business Mailing Address
First Line	:	7435 S EASTERN AVE STE 104
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1508
Country	:	US
Telephone Number	:	702-272-3790
Fax Number	:

Provider Business Practice Location Address
First Line	:	7435 S EASTERN AVE STE 104
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1508
Country	:	US
Telephone Number	:	702-272-3790
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LILIAN DIAZ LAGO
Credential	:	DMD
Telephone Number	:	702-272-3790

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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