1821200015 NPI number — CRESSMAN DENTAL GROUP, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821200015 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 SOUTH
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:
1821200015
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:
800 S MEADOWS
Provider Second Line Business Practice Location Address:
PARKWAY STE 100
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-851-4646
Provider Business Practice Location Address Fax Number:
775-851-4647
Provider Enumeration Date:
05/03/2007

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)





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