MEDICARE: CARLA JEAN LALANDE DMD

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	1223P0221X	Pediatric Dentistry	S6-89	NV
2	1223G0001X	General Practice Dentistry	0401411483	VA

General Provider Information

NPI Number	:	1245376409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA JEAN LALANDE DMD

Provider Business Mailing Address
First Line	:	3600 N BUFFALO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7444
Country	:	US
Telephone Number	:	702-254-8858
Fax Number	:	702-254-9462

Provider Business Practice Location Address
First Line	:	3600 N BUFFALO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7444
Country	:	US
Telephone Number	:	702-254-8858
Fax Number	:	702-254-9462

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	10/15/2008

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