MEDICARE: BNT ORTHODONTICS, LLC

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	S3-119	NV
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	S3-193C	NV

General Provider Information

NPI Number	:	1740538214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BNT ORTHODONTICS, LLC

Provider Business Mailing Address
First Line	:	1350 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8510
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8510
Country	:	US
Telephone Number	:	702-870-1350
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LEONARDO CARLOS BORDADOR
Credential	:	DMD, MS
Telephone Number	:	702-870-1350

Provider Enumeration Date	:	08/15/2012
Last Update Date	:	08/15/2012

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