Provider Demographics
NPI:1083090005
Name:CANDA, CATHERINE ARIEL
Entity Type:Individual
Prefix:
First Name:CATHERINE ARIEL
Middle Name:
Last Name:CANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ARIEL
Other - Middle Name:
Other - Last Name:CANDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6821 ARCADIA CREEK ST
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-3179
Mailing Address - Country:US
Mailing Address - Phone:702-379-3289
Mailing Address - Fax:
Practice Address - Street 1:6821 ARCADIA CREEK ST
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-3179
Practice Address - Country:US
Practice Address - Phone:702-379-3289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA648911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice