=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124571591
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALLEY PEDIATRIC DENTISTRY, HEATHER M PARSONS, DMD. LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2016
-----------------------------------------------------
Last Update Date | 08/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1701 COUNTY RD STE I
-----------------------------------------------------
City | MINDEN
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89423-4465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-782-8077
-----------------------------------------------------
Fax | 775-782-6199
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2260
-----------------------------------------------------
City | MINDEN
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89423-2260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-782-8077
-----------------------------------------------------
Fax | 775-782-6199
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. HEATHER M PARSONS
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 775-782-8077
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | S6-136
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------