Provider Demographics
NPI:1780219287
Name:CARLA CORDOVA DMD MSD LLC
Entity Type:Organization
Organization Name:CARLA CORDOVA DMD MSD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALANDE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-254-8858
Mailing Address - Street 1:3600 N BUFFALO DR STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7462
Mailing Address - Country:US
Mailing Address - Phone:702-254-8858
Mailing Address - Fax:702-254-9462
Practice Address - Street 1:3603 LAS VEGAS BLVD N STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-0588
Practice Address - Country:US
Practice Address - Phone:702-545-0055
Practice Address - Fax:702-254-9462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty