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Individual

DR. C LEONARD FATH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
1001 SHADOW LN, MS 7414, LAS VEGAS, NV 89106-4124
(702) 371-8000
Mailing address
1348 DUSTY CREEK ST, LAS VEGAS, NV 89128-2162
(702) 371-8000

Taxonomy

Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
S7-102
NV
1223G0001X
General Practice Dentistry
019-019555
IL
1223G0001X
General Practice Dentistry
4164
NV

Other

Enumeration date
10/04/2006
Last updated
11/01/2018
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