Provider Demographics
NPI:1710975420
Name:DALERE, MENTE (MD)
Entity Type:Individual
Prefix:
First Name:MENTE
Middle Name:
Last Name:DALERE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4513 SEA DREAM AVE
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-3483
Mailing Address - Country:US
Mailing Address - Phone:702-586-0830
Mailing Address - Fax:
Practice Address - Street 1:653 N TOWN CENTER DR STE 10
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0503
Practice Address - Country:US
Practice Address - Phone:702-733-0981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010452552080N0001X
NV131352080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2341592OtherECFMG
MI4589791Medicaid
4301045255OtherCONTROLLED SUBSTANCE
4301045255OtherCONTROLLED SUBSTANCE
MI4589791Medicaid