MEDICARE: DR. LADEANE KATHERINE FATTORE-BRUNO DDS

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	4287	NV
2	1223G0001X	General Practice Dentistry	D07776	AZ

General Provider Information

NPI Number	:	1750583985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LADEANE KATHERINE FATTORE-BRUNO DDS

Provider Business Mailing Address
First Line	:	3041 E. FLAMINGO ROAD
Second Line	:	SUITE C & D
City	:	LAS VEGAS
State	:	NV
Zip	:	89121
Country	:	US
Telephone Number	:	702-309-9001
Fax Number	:	702-309-9016

Provider Business Practice Location Address
First Line	:	3041 E. FLAMINGO ROAD
Second Line	:	SUITE C & D
City	:	LAS VEGAS
State	:	NV
Zip	:	89121
Country	:	US
Telephone Number	:	702-309-9001
Fax Number	:	702-309-9016

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

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	06/02/2015

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