=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528134350
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RANDALL JOSEPH PANE D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2006
-----------------------------------------------------
Last Update Date | 10/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10595 DOUBLE R BLVD
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89521-8909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-825-8463
-----------------------------------------------------
Fax | 775-332-8466
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5365 MAE ANNE AVE SUITE B-1
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89523-1840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-746-1957
-----------------------------------------------------
Fax | 775-746-8305
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 3062
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------