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General NPI Number Information
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NPI Number | 1639306517
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Entity Type | Organization
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Legal Business Name | JUST SMILES DENTAL CARE, MCGRUDER P.C.
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Dates
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Enumeration Date | 06/17/2009
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Last Update Date | 04/19/2013
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Provider Practice Location Address
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Address Line | 2900 CLEAR ACRE LN SUITE S
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City | RENO
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State | NV
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Zip | 89512-1712
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Country | US
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Telephone | 775-337-6453
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Fax | 775-337-2854
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Provider Business Mailing Address
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Address Line | 2900 CLEAR ACRE LN SUITE S
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City | RENO
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State | NV
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Zip | 89512-1712
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Country | US
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Telephone | 775-337-6453
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Fax | 775-337-2854
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. KEITH D MCGRUDER
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Credential | DDS
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Telephone | 775-671-8659
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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 | 5870
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License Number State | NV
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