Healthcare Provider Details

I. General information

NPI: 1659447688
Provider Name (Legal Business Name): HEALTHY SMILES FAMILY DENTISTRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BOVARD ST
YERINGTON NV
89447
US

IV. Provider business mailing address

120 BOVARD ST
YERINGTON NV
89447
US

V. Phone/Fax

Practice location:
  • Phone: 775-463-1800
  • Fax: 775-463-4810
Mailing address:
  • Phone: 775-463-1800
  • Fax: 775-463-4810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number4157
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MARLENA E BOOTH
Title or Position: CEO
Credential:
Phone: 775-463-1800