Healthcare Provider Details

I. General information

NPI: 1083201248
Provider Name (Legal Business Name): TEAM PERIO, INC., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 W 7TH ST STE 130
RENO NV
89503-2706
US

IV. Provider business mailing address

855 W 7TH ST STE 130
RENO NV
89503-2706
US

V. Phone/Fax

Practice location:
  • Phone: 775-447-1191
  • Fax:
Mailing address:
  • Phone: 775-447-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: ERIC BLASINGAME
Title or Position: PRESIDENT/OWNER/PERIODONTIST
Credential: DDS, MS
Phone: 530-241-3302