MEDICARE: DR. CAREY BRUCE NOORDA D.D.S., M.S.D.

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	2223 S3-37	NV

General Provider Information

NPI Number	:	1821196940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAREY BRUCE NOORDA D.D.S., M.S.D.

Provider Business Mailing Address
First Line	:	1701 N GREEN VALLEY PKWY STE 1
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-5886
Country	:	US
Telephone Number	:	702-737-5500
Fax Number	:	702-737-5565

Provider Business Practice Location Address
First Line	:	1701 N GREEN VALLEY PKWY STE 1
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-5886
Country	:	US
Telephone Number	:	702-737-5500
Fax Number	:	702-737-5565

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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