Healthcare Provider Details

I. General information

NPI: 1437211455
Provider Name (Legal Business Name): RAMIN HOMANFAR D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5420 KIETZKE LN STE 201
RENO NV
89511-2062
US

IV. Provider business mailing address

5420 KIETZKE LN STE 201
RENO NV
89511-2062
US

V. Phone/Fax

Practice location:
  • Phone: 775-827-5511
  • Fax: 775-852-4154
Mailing address:
  • Phone: 775-827-5511
  • Fax: 775-852-4154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number2939
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: