MEDICARE: CARLA LALANDE DMD MSD PC

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	261QD0000X	Dental Clinic/Center	5677	NV

General Provider Information

NPI Number	:	1821231838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLA LALANDE DMD MSD PC

Provider Business Mailing Address
First Line	:	3600 N BUFFALO DR
Second Line	:	#110
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7463
Country	:	US
Telephone Number	:	702-254-8858
Fax Number	:	702-254-9462

Provider Business Practice Location Address
First Line	:	3600 N BUFFALO DR
Second Line	:	#110
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7463
Country	:	US
Telephone Number	:	702-254-8858
Fax Number	:	702-254-9462

Authorized Official
Title or Position	:	PEDIATRIC DENTIST
Name	:	DR. CARLA LALANDE
Credential	:	DMD, MSD
Telephone Number	:	702-254-8858

Provider Enumeration Date	:	04/07/2009
Last Update Date	:	04/07/2009

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