| Carson Tahoe Oral And Maxillofacial Surgery | |
|
1470 Medical Pkwy Ste 260 Carson City NV 89703-4647 | |
| (775) 884-4433 | |
| (775) 884-4459 |
| Full Name | Carson Tahoe Oral And Maxillofacial Surgery |
|---|---|
| Speciality | Dentist |
| Location | 1470 Medical Pkwy Ste 260, Carson City, Nevada |
| Authorized Official Name and Position | Steven Victor Dryden (SOLE MEMBER) |
| Authorized Official Contact | 7758844433 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carson Tahoe Oral And Maxillofacial Surgery 1470 Medical Pkwy Ste 260 Carson City NV 89703-4647 Ph: (775) 884-4433 | Carson Tahoe Oral And Maxillofacial Surgery 1470 Medical Pkwy Ste 260 Carson City NV 89703-4647 Ph: (775) 884-4433 |
| NPI Number | 1144742933 |
|---|---|
| Provider Enumeration Date | 07/13/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 8022383678 |
|---|---|
| Medicare Enrollment ID | O20171006001298 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144742933 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | S2-148 (Nevada) | Primary |
| Provider Name | Steven Victor Dryden |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1952386146 PECOS PAC ID: 9931474582 Enrollment ID: I20171006001337 |
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