=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164577748
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NICK FURCHNER DDS LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2007
-----------------------------------------------------
Last Update Date | 07/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 605 SIERRA ROSE DR #5
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-322-4778
-----------------------------------------------------
Fax | 775-322-7963
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 605 SIERRA ROSE DR #5
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-322-4778
-----------------------------------------------------
Fax | 775-322-7963
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER OWNER
-----------------------------------------------------
Name | MRS. AMY ELLIS FURCHNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 775-322-4778
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 2302
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------