Healthcare Provider Details

I. General information

NPI: 1932011137
Provider Name (Legal Business Name): ANTOINE & HANSEN PERIODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 BAKER LN STE 2
RENO NV
89509-5441
US

IV. Provider business mailing address

10775 DOUBLE R BLVD STE 108
RENO NV
89521-8956
US

V. Phone/Fax

Practice location:
  • Phone: 775-524-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. NATHAN M. ANTOINE
Title or Position: PARTNER/OWNER
Credential: DMD, MS
Phone: 636-248-0197