Provider Demographics
NPI:1689462798
Name:LANDAVERDE, ANDY ALEXANDER
Entity type:Individual
Prefix:DR
First Name:ANDY
Middle Name:ALEXANDER
Last Name:LANDAVERDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 COVENTRY CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-2725
Mailing Address - Country:US
Mailing Address - Phone:702-541-2496
Mailing Address - Fax:
Practice Address - Street 1:1825 S NELLIS BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-6215
Practice Address - Country:US
Practice Address - Phone:702-452-3552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV82151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice