MEDICARE: DESERT VIEW DENTAL CR INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3204	NV

General Provider Information

NPI Number	:	1629152434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT VIEW DENTAL CR INC

Provider Business Mailing Address
First Line	:	1231 E BASIN RD
Second Line	:	STE 10
City	:	PAHRUMP
State	:	NV
Zip	:	89060
Country	:	US
Telephone Number	:	775-727-1366
Fax Number	:	775-727-7116

Provider Business Practice Location Address
First Line	:	1231 E BASIN RD
Second Line	:	STE 10
City	:	PAHRUMP
State	:	NV
Zip	:	89060
Country	:	US
Telephone Number	:	775-727-1366
Fax Number	:	775-727-7116

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RONALD LAMONTE CORNU
Credential	:	DMD
Telephone Number	:	775-727-1366

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	08/22/2020

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