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General NPI Number Information
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NPI Number | 1316510001
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Entity Type | Organization
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Legal Business Name | INCLINE DENTAL CARE, LLC
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Dates
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Enumeration Date | 07/20/2021
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Last Update Date | 07/20/2021
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Provider Practice Location Address
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Address Line | 231 VILLAGE BLVD
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City | INCLINE VILLAGE
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State | NV
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Zip | 89451-9415
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Country | US
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Telephone | 775-831-3466
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Fax |
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Provider Business Mailing Address
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Address Line | 3605 GRANT DR
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City | RENO
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State | NV
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Zip | 89509-5301
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Country | US
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Telephone | 775-409-4614
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | ALETA BEUTER
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Credential |
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Telephone | 775-409-4614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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