Healthcare Provider Details

I. General information

NPI: 1821883224
Provider Name (Legal Business Name): NICE SMILES RENO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 BRINKBY AVE
RENO NV
89509-4327
US

IV. Provider business mailing address

1363 PETAR DR
GARDNERVILLE NV
89410-5868
US

V. Phone/Fax

Practice location:
  • Phone: 775-446-7623
  • Fax:
Mailing address:
  • Phone: 775-671-8659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. KEITH MCGRUDER
Title or Position: PRESIDENT
Credential: DDS
Phone: 775-671-8659