Provider Demographics
NPI:1689614893
Name:LETELIER, CARLOS H (MD,DMD,DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:H
Last Name:LETELIER
Suffix:
Gender:M
Credentials:MD,DMD,DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
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
Practice Address - Country:US
Practice Address - Phone:702-367-6666
Practice Address - Fax:702-367-9555
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSPG139-AA1223D0004X
NVS2-40C204E00000X, 2082S0099X
NVGA146207L00000X
NV9658208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No1223D0004XDental ProvidersDentistDentist Anesthesiologist
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502133Medicaid