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NPI Code Detail

MEDICARE: DR. DEAUDRE LYNDELL LECATO DMD,MBA

MEDICARE: DR. DEAUDRE LYNDELL LECATO DMD,MBA
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
1122300000XDentist7573NV

General Provider Information

NPI Number : 1528720893
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEAUDRE LYNDELL LECATO DMD,MBA
Provider Business Mailing Address
First Line : 4760 DESERT VISTA RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-5627
Country : US
Telephone Number : 702-510-0928
Fax Number :
Provider Business Practice Location Address
First Line : 5001 E BONANZA RD STE 160
Second Line :
City : LAS VEGAS
State : NV
Zip : 89110-3560
Country : US
Telephone Number : 702-996-8347
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2021
Last Update Date : 10/13/2021

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