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General NPI Number Information
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NPI Number | 1891238614
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Entity Type | Organization
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Legal Business Name | DENTISTRY FOR KIDS, LLC
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Dates
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Enumeration Date | 11/28/2016
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Last Update Date | 11/28/2016
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Provider Practice Location Address
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Address Line | 10455 DOUBLE R BLVD STE 100
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City | RENO
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State | NV
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Zip | 89521-8905
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Country | US
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Telephone | 775-823-9797
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Fax | 775-823-9677
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Provider Business Mailing Address
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Address Line | 10455 DOUBLE R BLVD STE 100
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City | RENO
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State | NV
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Zip | 89521-8905
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Country | US
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Telephone | 775-823-9797
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Fax | 775-823-9677
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Authorized Official
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Title or Position | CEO
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Name | STEVE DELONG
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Credential |
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Telephone | 775-336-1510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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