Healthcare Provider Details

I. General information

NPI: 1952386146
Provider Name (Legal Business Name): STEVEN VICTOR DRYDEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 MEDICAL PKWY STE 260
CARSON CITY NV
89703-4647
US

IV. Provider business mailing address

1470 MEDICAL PKWY STE 260
CARSON CITY NV
89703-4647
US

V. Phone/Fax

Practice location:
  • Phone: 775-884-4433
  • Fax: 775-884-4459
Mailing address:
  • Phone: 775-884-4433
  • Fax: 775-884-4459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number59322109921
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberS2-148
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5932210-9921
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number15497
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: