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General NPI Number Information
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NPI Number | 1902795453
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Entity Type | Individual
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Provider Name | DIANNE ELTAGUNDE
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Gender | Female
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 2454 WINGFIELD HILLS RD STE 100
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City | SPARKS
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State | NV
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Zip | 89436-7202
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Country | US
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Telephone | 775-525-5510
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Fax |
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Provider Business Mailing Address
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Address Line | 1234 SABATA WAY APT 3173
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City | SPARKS
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State | NV
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Zip | 89436-1946
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Country | US
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Telephone | 209-233-2766
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8251
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License Number State | NV
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