Provider Demographics
NPI:1114036969
Name:DE ANDRADE, EDILBERTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDILBERTO
Middle Name:
Last Name:DE ANDRADE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2869
Mailing Address - Country:US
Mailing Address - Phone:702-270-4600
Mailing Address - Fax:702-270-7773
Practice Address - Street 1:2610 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2869
Practice Address - Country:US
Practice Address - Phone:702-270-4600
Practice Address - Fax:702-270-7773
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS4-241223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics