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General NPI Number Information
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NPI Number | 1144827767
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Entity Type | Organization
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Legal Business Name | SMILERESTORE
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Dates
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Enumeration Date | 10/06/2020
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 5365 MAE ANNE AVE STE B1
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City | RENO
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State | NV
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Zip | 89523-1897
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Country | US
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Telephone | 775-800-1051
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Fax | 775-313-9032
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Provider Business Mailing Address
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Address Line | 5365 MAE ANNE AVE STE B1
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City | RENO
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State | NV
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Zip | 89523-1897
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Country | US
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Telephone | 775-800-1051
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Fax | 775-313-9032
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Authorized Official
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Title or Position | DENTIST/EXECUTIVE DIRECTOR
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Name | DR. GEORGENE BERNICE CHASE
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Credential | DDS
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Telephone | 775-800-1051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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