Healthcare Provider Details

I. General information

NPI: 1871097139
Provider Name (Legal Business Name): INNOVATIVE SLEEP CONCEPTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 SANDHILL RD STE 200
RENO NV
89521-8963
US

IV. Provider business mailing address

730 SANDHILL RD STE 200
RENO NV
89521-8963
US

V. Phone/Fax

Practice location:
  • Phone: 775-477-5337
  • Fax: 775-360-4131
Mailing address:
  • Phone: 775-477-5337
  • Fax: 775-360-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: JASON RYAN DOUCETTE
Title or Position: OWNER
Credential: DMD
Phone: 775-477-5337