1427220037 NPI number — NORTHERN NEVADA DENTAL HEALTH PROGRAMS

Table of content: (NPI 1427220037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427220037 NPI number — NORTHERN NEVADA DENTAL HEALTH PROGRAMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN NEVADA DENTAL HEALTH PROGRAMS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HEALTHY SMILE HEALTHY CHILD
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427220037
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5605 RIGGINS CT STE 101A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89502-6575
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-982-7989
Provider Business Mailing Address Fax Number:
775-337-0298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5605 RIGGINS CT STE 101A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89502-6575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-982-7989
Provider Business Practice Location Address Fax Number:
775-337-0298
Provider Enumeration Date:
03/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PISANI
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
775-337-0296

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 002216200 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002216008 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com