Healthcare Provider Details

I. General information

NPI: 1689463440
Provider Name (Legal Business Name): ENDO MTB PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5420 KIETZKE LN STE 100
RENO NV
89511-2063
US

IV. Provider business mailing address

5420 KIETZKE LN STE 100
RENO NV
89511-2063
US

V. Phone/Fax

Practice location:
  • Phone: 775-825-5221
  • Fax:
Mailing address:
  • Phone: 775-825-5221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. BENJAMIN TAFT BROWN
Title or Position: OWNER
Credential: DMD, MSD
Phone: 775-825-5221