Provider Demographics
NPI:1316212772
Name:CHILDREN'S DENTAL SPECIALISTS, LLP
Entity Type:Organization
Organization Name:CHILDREN'S DENTAL SPECIALISTS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LALANDE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:702-658-6700
Mailing Address - Street 1:3600 N BUFFALO DR
Mailing Address - Street 2:110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7463
Mailing Address - Country:US
Mailing Address - Phone:702-254-8858
Mailing Address - Fax:702-254-9462
Practice Address - Street 1:6169 S RAINBOW BLVD
Practice Address - Street 2:100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3230
Practice Address - Country:US
Practice Address - Phone:702-658-6700
Practice Address - Fax:702-254-9462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV56771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty