MEDICARE: JESSE E CARDENAS

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	6355	NV

General Provider Information

NPI Number	:	1730426222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE E CARDENAS

Provider Business Mailing Address
First Line	:	526 S TONOPAH DR
Second Line	:	#200
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4043
Country	:	US
Telephone Number	:	702-435-5015
Fax Number	:	702-366-1483

Provider Business Practice Location Address
First Line	:	1155 W 4TH ST
Second Line	:	#229
City	:	RENO
State	:	NV
Zip	:	89503-5172
Country	:	US
Telephone Number	:	775-322-0800
Fax Number	:	775-322-0900

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

Provider Enumeration Date	:	01/03/2013
Last Update Date	:	01/03/2013

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Directions to “ JESSE E CARDENAS ” Practice Location

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