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NPI Code Detail

MEDICARE: JERROLD P CANSDALE DDS

MEDICARE: JERROLD P CANSDALE 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
1122300000XDentist2050NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22050OTHERNVNV DENTAL LICENSE

General Provider Information

NPI Number : 1326069634
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERROLD P CANSDALE DDS
Provider Business Mailing Address
First Line : 1802 N CARSON ST
Second Line : SUITE 100
City : CARSON CITY
State : NV
Zip : 89701-1265
Country : US
Telephone Number : 775-888-6610
Fax Number : 775-887-7046
Provider Business Practice Location Address
First Line : 2212 S EASTERN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-4124
Country : US
Telephone Number : 702-735-9334
Fax Number : 702-735-9335
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2006
Last Update Date : 08/13/2012

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Directions to “ JERROLD P CANSDALE DDS” Practice Location

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