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General NPI Number Information
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NPI Number | 1811403900
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Entity Type | Organization
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Legal Business Name | NORTHERN NEVADA FAMILY DENTAL
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Dates
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Enumeration Date | 12/27/2017
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Last Update Date | 12/27/2017
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Provider Practice Location Address
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Address Line | 5901 S LOS ALTOS PKWY STE 100
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City | SPARKS
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State | NV
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Zip | 89436-7667
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Country | US
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Telephone | 775-626-7772
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Fax | 775-626-7811
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Provider Business Mailing Address
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Address Line | 5901 S LOS ALTOS PKWY STE 100
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City | SPARKS
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State | NV
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Zip | 89436-7667
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Country | US
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Telephone | 775-626-7772
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Fax | 775-626-7811
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Authorized Official
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Title or Position | MANAGER
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Name | LITTLEJOHN K VANHORN
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Credential | DDS
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Telephone | 775-626-7772
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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 | 5122
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License Number State | NV
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