MEDICARE: DR. ANDY ALEXANDER LANDAVERDE

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	1223G0001X	General Practice Dentistry	8215	NV

General Provider Information

NPI Number	:	1689462798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDY ALEXANDER LANDAVERDE

Provider Business Mailing Address
First Line	:	115 COVENTRY CIR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-2725
Country	:	US
Telephone Number	:	702-541-2496
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 S NELLIS BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-6215
Country	:	US
Telephone Number	:	702-452-3552
Fax Number	:

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

Provider Enumeration Date	:	04/28/2025
Last Update Date	:	06/23/2025

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