Provider Demographics
NPI:1144331588
Name:ED DEANDRADE DDS, LTD.
Entity type:Organization
Organization Name:ED DEANDRADE DDS, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:DE ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-270-4600
Mailing Address - Street 1:2610 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE #202
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2869
Mailing Address - Country:US
Mailing Address - Phone:702-270-4600
Mailing Address - Fax:702-270-7773
Practice Address - Street 1:2610 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE #202
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2869
Practice Address - Country:US
Practice Address - Phone:702-270-4600
Practice Address - Fax:702-270-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV35861223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty