MEDICARE: PARADISE ORTHODONTICS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1649872631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARADISE ORTHODONTICS

Provider Business Mailing Address
First Line	:	4540 S PECOS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5923
Country	:	US
Telephone Number	:	702-436-0999
Fax Number	:

Provider Business Practice Location Address
First Line	:	4540 S PECOS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5923
Country	:	US
Telephone Number	:	702-436-0999
Fax Number	:

Authorized Official
Title or Position	:	INSURANCE SPECIALIST
Name	:	LEISA TORRENS
Credential	:
Telephone Number	:	702-360-3759

Provider Enumeration Date	:	11/13/2020
Last Update Date	:	11/13/2020

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Directions to “PARADISE ORTHODONTICS ” Practice Location

Language	Start Address	Practice Location

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