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General NPI Number Information
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NPI Number | 1821883224
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Entity Type | Organization
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Legal Business Name | NICE SMILES RENO, PLLC
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Dates
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Enumeration Date | 04/14/2025
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 175 BRINKBY AVE
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City | RENO
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State | NV
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Zip | 89509-4327
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Country | US
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Telephone | 775-446-7623
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Fax |
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Provider Business Mailing Address
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Address Line | 1363 PETAR DR
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City | GARDNERVILLE
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State | NV
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Zip | 89410-5868
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Country | US
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Telephone | 775-671-8659
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEITH 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 | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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