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General NPI Number Information
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NPI Number | 1265910970
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Entity Type | Organization
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Legal Business Name | MARVEL DENTAL CARSON CITY, LLC
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Dates
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Enumeration Date | 08/03/2018
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Last Update Date | 11/21/2018
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Provider Practice Location Address
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Address Line | 410 FLEISCHMANN WAY SUITE A.
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City | CARSON CITY
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State | NV
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Zip | 89703
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Country | US
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Telephone | 775-884-3322
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Fax | 775-884-4432
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Provider Business Mailing Address
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Address Line | 410 FLEISCHMANN WAY SUITE A.
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City | CARSON CITY
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State | NV
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Zip | 89703
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Country | US
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Telephone | 775-884-3322
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Fax | 775-884-4432
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Authorized Official
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Title or Position | CONSULTANT
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Name | ANGELA K. GOLDEN
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Credential |
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Telephone | 775-884-3322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 4821
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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