MEDICARE: NORTHERN NEVADA DENTAL HEALTH PROGRAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427220037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN NEVADA DENTAL HEALTH PROGRAMS

Provider Business Mailing Address
First Line	:	5605 RIGGINS CT STE 101A
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89502-6575
Country	:	US
Telephone Number	:	775-982-7989
Fax Number	:	775-337-0298

Provider Business Practice Location Address
First Line	:	5605 RIGGINS CT STE 101A
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89502-6575
Country	:	US
Telephone Number	:	775-982-7989
Fax Number	:	775-337-0298

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GREGORY J PISANI
Credential	:	DDS
Telephone Number	:	775-337-0296

Provider Enumeration Date	:	03/24/2008
Last Update Date	:	03/17/2018

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