| Summit Boulevard Dental | |
|
13985 S Virginia St Ste 806 Reno NV 89511-8934 | |
| (775) 846-4777 | |
| (775) 525-5512 |
| Full Name | Summit Boulevard Dental |
|---|---|
| Speciality | Dentist |
| Location | 13985 S Virginia St Ste 806, Reno, Nevada |
| Authorized Official Name and Position | Timothy Adams (OWNER) |
| Authorized Official Contact | 6156014728 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Summit Boulevard Dental 13985 S Virginia St Ste 806 Reno NV 89511-8934 Ph: (775) 846-4777 | Summit Boulevard Dental 13985 S Virginia St Ste 806 Reno NV 89511-8934 Ph: (775) 846-4777 |
| NPI Number | 1063900595 |
|---|---|
| Provider Enumeration Date | 04/30/2018 |
| Last Update Date | 04/30/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063900595 | NPI | - | NPPES |
| 1306026679 | Other | DENTISTRY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | S7-88C (Nevada) | Primary |
| 1223E0200X | Dentist - Endodontics | S7-881 (Nevada) | Secondary |
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