Active NPI
Brett Alan Noorda, D.M.D.
- General Practice Dentistry
- Henderson, NV
National Provider Identifier
1366460446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 3061
- Practice address
- 66 N Pecos Rd
Suite B
Henderson, NV 89074-7337 - Phone
- (702) 456-7403
- Fax
- (702) 434-7498
- NPI assigned
- Jul 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3061 | NV | Primary |
Addresses
Primary practice location
66 N Pecos Rd
Suite B
Henderson, NV 89074-7337
Mailing address
66 N Pecos Rd
Suite B
Henderson, NV 89074-7337
Phone (702) 456-7403
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 8, 2023 through Mar 8, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3061 | NV | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410912000000",
"number": "1366460446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "66 N PECOS RD",
"address_2": "SUITE B",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890747337",
"telephone_number": "702-456-7403",
"fax_number": "702-434-7498"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "66 N PECOS RD",
"address_2": "SUITE B",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890747337",
"telephone_number": "702-456-7403",
"fax_number": "702-434-7498"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOORDA",
"first_name": "BRETT",
"middle_name": "ALAN",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-17",
"last_updated": "2014-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NV",
"license": "3061",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Henderson, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.