Healthcare Provider Details

I. General information

NPI: 1093608705
Provider Name (Legal Business Name): NICHOLAS KALLAS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2025
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MCFAUL WAY
ZEPHYR COVE NV
89448-9807
US

IV. Provider business mailing address

120 MCFAUL WAY
ZEPHYR COVE NV
89448-9807
US

V. Phone/Fax

Practice location:
  • Phone: 775-588-5183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8201
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: