Provider Demographics
NPI:1366460446
Name:NOORDA, BRETT ALAN (DMD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:ALAN
Last Name:NOORDA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 N PECOS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7337
Mailing Address - Country:US
Mailing Address - Phone:702-456-7403
Mailing Address - Fax:702-434-7498
Practice Address - Street 1:66 N PECOS RD
Practice Address - Street 2:SUITE B
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7337
Practice Address - Country:US
Practice Address - Phone:702-456-7403
Practice Address - Fax:702-434-7498
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV30611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice