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General NPI Number Information
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NPI Number | 1164577003
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Entity Type | Organization
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Legal Business Name | ERIC B. PENDLETON, D.D.S., LTD.
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 601 W MOANA LN SUITE 4
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City | RENO
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State | NV
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Zip | 89509-4955
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Country | US
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Telephone | 775-825-5711
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Fax |
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Provider Business Mailing Address
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Address Line | 601 W MOANA LN SUITE 4
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City | RENO
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State | NV
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Zip | 89509-4955
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Country | US
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Telephone | 775-825-5711
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERIC BRUCE PENDLETON
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Credential | D.D.S.
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Telephone | 775-825-5711
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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 | 4568
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License Number State | NV
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