Healthcare Provider Details

I. General information

NPI: 1306981659
Provider Name (Legal Business Name): TARA LYNN VANORDEN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 KUENZLI ST
RENO NV
89502-1117
US

IV. Provider business mailing address

1715 KUENZLI ST
RENO NV
89502-1117
US

V. Phone/Fax

Practice location:
  • Phone: 775-329-5162
  • Fax: 775-334-4361
Mailing address:
  • Phone: 775-329-5162
  • Fax: 775-334-4361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDE00009193
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number5086
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: