Active NPI
C Leonard Fath, D.D.S.
- Endodontics
- Las Vegas, NV
National Provider Identifier
1033204243
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- S7-102
- Practice address
- 1001 Shadow LN
Ms 7414
Las Vegas, NV 89106-4124 - Phone
- (702) 371-8000
- NPI assigned
- Oct 4, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4164 | NV | |
| General Practice Dentistry | 1223G0001X | 019-019555 | IL | |
| Endodontics | 1223E0200X | S7-102 | NV | Primary |
Addresses
Primary practice location
1001 Shadow LN
Ms 7414
Las Vegas, NV 89106-4124
Mailing address
1348 Dusty Creek St
Las Vegas, NV 89128-2162
Phone (702) 371-8000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S7-102 | NV | MD | Endodontist |
| 019-019555 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1541030400000",
"number": "1033204243",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1348 DUSTY CREEK ST",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891282162",
"telephone_number": "702-371-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 SHADOW LN",
"address_2": "MS 7414",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891064124",
"telephone_number": "702-371-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FATH",
"first_name": "C",
"middle_name": "LEONARD",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-04",
"last_updated": "2018-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NV",
"license": "4164",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019-019555",
"primary": false
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NV",
"license": "S7-102",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.