1417164765 NPI number — CRESSMAN DENTAL GROUP, PC

Table of content: ERICKA NICOLE NORRIS LSW (NPI 1972273753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417164765 NPI number — CRESSMAN DENTAL GROUP, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRESSMAN DENTAL GROUP, PC
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:
GENTLE DENTAL RENO
Provider Other Organization Name Type Code:
3
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:
1417164765
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9800 S LA CIENEGA BLVD
Provider Second Line Business Mailing Address:
STE 899, ROOM 4
Provider Business Mailing Address City Name:
INGLEWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90301-4440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-684-6440
Provider Business Mailing Address Fax Number:
877-725-7443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 E MOANA LN
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89502-4671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-823-5100
Provider Business Practice Location Address Fax Number:
775-823-5101
Provider Enumeration Date:
05/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CRESSMAN
Authorized Official First Name:
TODD
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PC OWNER/PRESIDENT
Authorized Official Telephone Number:
800-684-6440

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  3516 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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