Individual
JERROLD P CANSDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2212 S EASTERN AVE, LAS VEGAS, NV 89104-4124
(702) 735-9334
(702) 735-9335
Mailing address
1802 N CARSON ST, SUITE 100, CARSON CITY, NV 89701-1265
(775) 888-6610
(775) 887-7046
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2050
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326069634
—
NV
01
—
2050
NV DENTAL LICENSE
NV
Enumeration date
07/21/2006
Last updated
08/13/2012
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