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General NPI Number Information
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NPI Number | 1902512387
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Entity Type | Organization
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Legal Business Name | COMMUNITY DENTAL CONNECTIONS, INC.
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Dates
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Enumeration Date | 01/27/2023
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Last Update Date | 01/27/2023
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Provider Practice Location Address
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Address Line | 4331 ROUNDSTONE DR
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City | SPARKS
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State | NV
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Zip | 89436-1606
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Country | US
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Telephone | 775-224-4323
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Fax |
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Provider Business Mailing Address
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Address Line | 4331 ROUNDSTONE DR
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City | SPARKS
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State | NV
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Zip | 89436-1606
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Country | US
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Telephone | 775-224-4323
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LANCETTE VANGUILDER
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Credential | RDH
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Telephone | 775-224-4270
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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 |
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License Number State |
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