Provider Demographics
NPI:1386838134
Name:LEINASSAR, ANDREA NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:NICOLE
Last Name:LEINASSAR
Suffix:
Gender:F
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:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:SMITH
Mailing Address - State:NV
Mailing Address - Zip Code:89430-0129
Mailing Address - Country:US
Mailing Address - Phone:775-465-2388
Mailing Address - Fax:775-465-2178
Practice Address - Street 1:2311 HIGHWAY 208
Practice Address - Street 2:
Practice Address - City:SMITH
Practice Address - State:NV
Practice Address - Zip Code:89430-9709
Practice Address - Country:US
Practice Address - Phone:775-465-2388
Practice Address - Fax:775-465-2178
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV56001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice