Healthcare Provider Details

I. General information

NPI: 1679162127
Provider Name (Legal Business Name): SMILES BY BOCCHI PLLC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14845 CORSICA CT
RENO NV
89511-4514
US

IV. Provider business mailing address

14845 CORSICA CT
RENO NV
89511-4514
US

V. Phone/Fax

Practice location:
  • Phone: 775-588-8484
  • Fax:
Mailing address:
  • Phone: 775-588-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JOHN BOCCHI
Title or Position: OWNER
Credential:
Phone: 775-588-8484