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General NPI Number Information
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NPI Number | 1285017392
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Entity Type | Organization
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Legal Business Name | NORTHERN NEVADA DENTAL SPECIALTIES GROUP, LLC
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 5220 NEIL RD SUITE 110
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City | RENO
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State | NV
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Zip | 89502-6505
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Country | US
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Telephone | 775-964-8762
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Fax |
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Provider Business Mailing Address
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Address Line | 5220 NEIL RD SUITE 110
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City | RENO
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State | NV
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Zip | 89502-6505
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Country | US
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Telephone | 775-964-8762
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Fax |
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Authorized Official
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Title or Position | COO
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Name | ROGER HELWIG
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Credential |
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Telephone | 775-336-1510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | S3-244
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License Number State | NV
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