Healthcare Provider Details

I. General information

NPI: 1316510001
Provider Name (Legal Business Name): INCLINE DENTAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 VILLAGE BLVD
INCLINE VILLAGE NV
89451-9415
US

IV. Provider business mailing address

3605 GRANT DR
RENO NV
89509-5301
US

V. Phone/Fax

Practice location:
  • Phone: 775-831-3466
  • Fax:
Mailing address:
  • Phone: 775-409-4614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ALETA BEUTER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 775-409-4614