Provider Demographics
NPI:1285025130
Name:CARLOS H LETELIER MD DMD DDS A P C
Entity Type:Organization
Organization Name:CARLOS H LETELIER MD DMD DDS A P C
Other - Org Name:THE CENTER FOR ORAL SURGERY OF LAS VEGAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:H
Authorized Official - Last Name:LETELIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD DMD, DDS
Authorized Official - Phone:702-367-6666
Mailing Address - Street 1:10115 W TWAIN AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-6718
Mailing Address - Country:US
Mailing Address - Phone:702-367-6666
Mailing Address - Fax:702-367-9555
Practice Address - Street 1:10115 W TWAIN AVE
Practice Address - Street 2:STE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-6718
Practice Address - Country:US
Practice Address - Phone:702-367-6666
Practice Address - Fax:702-367-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1689614893Medicaid