MEDICARE: STEAD DENTAL CLINIC

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	1223G0001X	General Practice Dentistry	2787	NV

General Provider Information

NPI Number	:	1952372708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEAD DENTAL CLINIC

Provider Business Mailing Address
First Line	:	1055 N HILLS BLVD
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89506-8691
Country	:	US
Telephone Number	:	775-677-1055
Fax Number	:	775-677-1081

Provider Business Practice Location Address
First Line	:	1055 N HILLS BLVD
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89506-8691
Country	:	US
Telephone Number	:	775-677-1055
Fax Number	:	775-677-1081

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT FRASER DEVIN
Credential	:	DDS
Telephone Number	:	775-677-1055

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	09/17/2008

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Directions to “STEAD DENTAL CLINIC ” Practice Location

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